• Michael J Brenner, Vinciya Pandian, Carly E Milliren, Dionne A Graham, Charissa Zaga, Linda L Morris, Joshua R Bedwell, Preety Das, Hannah Zhu, John Lee Y Allen, Alon Peltz, Kimberly Chin, Bradley A Schiff, Diane M Randall, Chloe Swords, Darrin French, Erin Ward, Joanne M Sweeney, Stephen J Warrillow, Asit Arora, Anthony Narula, Brendan A McGrath, Tanis S Cameron, and David W Roberson.
• University of Michigan, Ann Arbor, MI, USA.
• Br J Anaesth. 2020 Jul 1; 125 (1): e104-e118.

AbstractThere is growing recognition of the need for a coordinated, systematic approach to caring for patients with a tracheostomy. Tracheostomy-related adverse events remain a pervasive global problem, accounting for half of all airway-related deaths and hypoxic brain damage in critical care units. The Global Tracheostomy Collaborative (GTC) was formed in 2012 to improve patient safety and quality of care, emphasising knowledge, skills, teamwork, and patient-centred approaches. Inspired by quality improvement leads in Australia, the UK, and the USA, the GTC implements and disseminates best practices across hospitals and healthcare trusts. Its database collects patient-level information on quality, safety, and organisational efficiencies. The GTC provides an organising structure for quality improvement efforts, promoting safety of paediatric and adult patients. Successful implementation requires instituting key drivers for change that include effective training for health professionals; multidisciplinary team collaboration; engagement and involvement of patients, their families, and carers; and data collection that allows tracking of outcomes. We report the history of the collaborative, its database infrastructure and analytics, and patient outcomes from more than 6500 patients globally. We characterise this patient population for the first time at such scale, reporting predictors of adverse events, mortality, and length of stay indexed to patient characteristics, co-morbidities, risk factors, and context. In one example, the database allowed identification of a previously unrecognised association between bleeding and mortality, reflecting ability to uncover latent risks and promote safety. The GTC provides the foundation for future risk-adjusted benchmarking and a learning community that drives ongoing quality improvement efforts worldwide.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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