Tracheostomy Timeout Design and Feedback
Airway providers provided various suggestions for tracheostomy time-out
design with a common emphasis on the following topics: COVID-19 status
verification, confirming PPE and equipment availability, coordination
with anesthesia team, paralytic and reversal plans, electrocautery
settings and FiO2 levels near airway, confirming anticipated periods of
holding ventilation with open circuit, avoiding tracheal suctioning
after tracheotomy, and use of viral filters for ventilator circuit, ETT,
and tracheostomy tube. These recommendations were used to create a
specific timeout targeting tracheostomy safety measures (Figure 1). The
tracheostomy time-out is conducted by the surgical team immediately
after completing the general surgical timeout. The middle portion of the
time-out, highlighted in the colored background, emphasizes
intra-operative safety measures to reduce risk of aerosolization and
airway fire; this portion is repeated when the surgical team is close to
entering the airway. A hardcopy of the time-out should available in the
operating room and be posted in a common area where both surgical and
anesthesiology teams can have access (i.e. side of anesthesia
workstation). Team debriefing is encouraged at the end of the case to
review what went well and assess for areas of improvement. The draft of
the time-out was sent to a total of 102 physicians for feedback: a mix
of Otolaryngologists, General Surgeons, Thoracic Surgeons, and
Anesthesiologists. There was an overall positive reception to the idea
of implementing a tracheostomy time-out. One provider noted that the
wording “time-out” may lead to confusion with the general surgical
time-out. In order to prevent any confusion, we added an opening
statement emphasizing that the tracheostomy time-out should follow the
completion of the general time-out. With continued use, we hope that
providers can easily integrate the tracheostomy time-out as an extension
of the general surgical time-out.