ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A...
-
Upload
nhs -
Category
Health & Medicine
-
view
233 -
download
0
Transcript of ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A...
![Page 1: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/1.jpg)
DR KAREN ORR, ST7 ICM/ANAESTHETICS, UHD
DR CONN RUSSELL, CONSULTANT INTENSIVE CARE/ANAESTHETICS, UHD
DR CHARLES PHILPOTT, CONSULTANT ANAESTHETICS, UHD
Intensive Care Medicine Trainees’
experience of Percutaneous Dilatational
Tracheostomy Insertion:
A UK wide survey
![Page 2: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/2.jpg)
• Background
• Outline of survey design
• Results
•All trainees, ST7+ trainees, NI trainees
• Discussion
![Page 3: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/3.jpg)
BACKGROUND
![Page 4: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/4.jpg)
NCEPOD “On the right Trach?” (2014)
• Estimated 8000 PDT insertions annually in the UK
http://www.ncepod.org.uk/2014report1/downloads/On%20the%20Right%20Trach_FullReport.pdf
![Page 5: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/5.jpg)
![Page 6: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/6.jpg)
• Lethal cases btwn 1985 and 2003
• 71 cases: 0.17% of all pts. or 1 in 600 pts.
• 31% during procedure
• Haemorrhage (38%), airway complications (29.6%),
tracheal perforation (15.5%), PTX (5.6%),
bronchospasm (4.4%), arrhythmia/cardiac arrest
(4.4%) and sepsis (1.5%)
• Bronchoscopic guidance only in 46.5%
![Page 7: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/7.jpg)
![Page 8: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/8.jpg)
![Page 9: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/9.jpg)
![Page 10: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/10.jpg)
![Page 11: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/11.jpg)
Competency Level Descriptors
![Page 12: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/12.jpg)
Domain 5: Practical procedures
ACCS CAT CMT ST Stage 2 Stage 3
5.6 Performs percutaneous tracheostomy
0 0 0 1 3 4
![Page 13: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/13.jpg)
![Page 14: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/14.jpg)
![Page 15: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/15.jpg)
SURVEY DESIGN
![Page 16: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/16.jpg)
Survey Content
• Demographics
• Experience of PDT insertion
•Direct/ indirect supervision
• Self perceived level of competency
![Page 17: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/17.jpg)
DEMOGRAPHICS
![Page 18: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/18.jpg)
• Approximately 400 UK ICM trainees
• 116 complete responses (29%)
• 6 Northern Ireland responses (75%)
• 39 trainees at ST7 level and above
• All training grades, deaneries and base
specialities represented
![Page 19: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/19.jpg)
Number of PDTs performed in career so far - Direct supervision
All trainees, completed responses only
43%
4%9%4%
9%
9%
4%3% 7%
0%8% Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
![Page 20: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/20.jpg)
Number of PDTs performed in career so far- Indirect Supervision
All trainees, completed responses only
71%
9%
4% 5%
2% 2%2%
1% 1%1% 2%
Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
![Page 21: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/21.jpg)
PERCEIVED COMPETENCY
![Page 22: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/22.jpg)
Do you feel competent to perform a PDT with direct supervision?
All trainees, completed responses only
86%
14%
Yes
No
![Page 23: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/23.jpg)
Do you feel competent to perform a PDT with indirect supervision?
All trainees, completed responses only
44%
56% Yes
No
![Page 24: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/24.jpg)
TRAINEES ST7 AND ABOVE
![Page 25: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/25.jpg)
Number of PDTs performed in career so far- Direct supervision
59%
0%2%
5%
3%
8%
3%0%
10%
0% 10% Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Trainees ST7+, completed responses only
![Page 26: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/26.jpg)
Number of PDTs performed in career so far- Indirect Supervision
51%
15%
5%
8%
2%0% 5%
3%3% 3%
5% Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Trainees ST7+, completed responses only
![Page 27: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/27.jpg)
Do you feel competent to perform a PDT with direct supervision?
Trainees ST7+, completed responses only
95%
5%
Yes
No
![Page 28: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/28.jpg)
Do you feel competent to perform a PDT with indirect supervision?
Trainees ST7+, completed responses only
69%
31%
Yes
No
![Page 29: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/29.jpg)
NORTHERN IRELAND TRAINEES
![Page 30: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/30.jpg)
Number of PDTs performed in career so far- Direct supervision
NI trainees, completed responses only
33%
0%33%
17%
0%17%
0% 0% 0% 0% 0%
Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
![Page 31: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/31.jpg)
Number of PDTs performed in career so far- Indirect Supervision
NI trainees, completed responses only
83%
17%
0%0%0%0%0%0%0%0%0%Zero
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
![Page 32: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/32.jpg)
Do you feel competent to perform a PDT with direct supervision?
NI trainees, completed responses only
50%50%
Yes
No
![Page 33: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/33.jpg)
Do you feel competent to perform a PDT with indirect supervision?
NI trainees, completed responses only
17%
83%
Yes
No
![Page 34: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/34.jpg)
COMPARISONALL TRAINEES V ST7+ V NI
![Page 35: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/35.jpg)
All TraineesST7+
TraineesNI Trainees
Career, >2 PDT- Direct
61/11652.6%
16/3941.0%
4/666.7%
Career, >2 PDT- Indirect
23/11619.8%
13/3933.3%
1/616.7%
% Self perceived
competency-Direct
100/11686.2%
37/3994.9%
3/650%
% Self perceived
competency-Indirect
51/11644.0%
27/3969.2%
1/616.7%
![Page 36: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/36.jpg)
COMMENTS
![Page 37: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/37.jpg)
Additional Trainee Comments
• Generally inadequate exposure and training opportunities
lacking- many responses from trainees
• Wide variety in training opportunities
• Seldinger technique is a generic skill and PDT should only
require a small number of supervised observations
• Number of PDTs inserted is falling and with it, exposure for
training
• Some consultants struggling to maintain their own skills with
falling numbers , before training junior staff
![Page 38: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/38.jpg)
• Should a small number of consultants in each unit
maintain PDT insertion skills- a specialist rather than
generic skill?
• Skills in managing complications e.g. bleeding are lacking
• Variation between units on focus on training ICM trainees
specifically (above anaesthetic trainees or speciality
doctors for example)
• Uncommon to perform without a consultant present
undertaking bronchoscopy
![Page 39: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/39.jpg)
CONCLUSION
![Page 40: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/40.jpg)
• 86% of all, 95% of ST7+ and 50% of NI trainees feel
competent to perform PDT insertion with direct
supervision
• 44%, 69% and 17% respectively with indirect supervision
• Some inaccuracies with reported numbers, particularly
ST7+ trainees
• Perceived inadequacy of training opportunities (falling
numbers, consultant skill maintenance, training of non
ICM trainee doctors)
• Should it remain a core skill for all Intensivists?
![Page 41: ntensive Care Medicine Trainees’ experience of Percutaneous Dilatational Tracheostomy Insertion: A UK wide survey](https://reader034.fdocuments.us/reader034/viewer/2022042716/55aeeb281a28abc0258b45fd/html5/thumbnails/41.jpg)
Thanks
• Dr Conn Russell (Consultant Intensive Care,
UHD)
• Dr Charles Philpott (Consultant Anaesthetist,
UHD)