This multi-institutional project demonstrated how a structured approach to interprofessional collaboration and patient engagement can mitigate preventable harm and improve patient experience for patients with a surgical airway (tracheostomy). Care of such patients is high stakes and fraught with risk. Harm occurs in hospital settings and in the community because poor communication and fragmented care are pervasive. Poor coordination of care contributes to anxiety, frustrations, and complications. Avoidable visits to emergency departments or injury are all too common. We applied an interprofessional approach involving patients, families, nurses, social workers, pharmacists, physicians, and other stakeholders to counteract these problems.
The interprofessional education and practice approach improved quality and safety of care through partnership with patients and families. The effort involved diverse health professionals and was conducted using mixed-methods interviews, focus groups, and assessments of anxiety and depression. Using appreciative inquiry, interviews, and Normalization Measure Development questionnaires, we showed improvements in staff engagement (1536 questionnaires from 1019 staff) across 2405 admissions in 20 hospitals. Furthermore, the median length of stay was reduced, as were complications and mortality. There were significant reductions in ICU and hospital days (P< 0.01). Time to speech and oral intake decreased by 7 days (n=733; P< 0.01). Anxiety decreased by 44%, from 35.9% to 20.0%, and depression decreased by 55%, from 38.7% to 18.3% (p< 0.01). Economic analysis demonstrated average savings of thousands of dollars per patient.
These data demonstrate that interprofessional collaboration can be applied at large scale when a purposeful approach is taken to engaging patients, committing to shared interprofessional education, and tracking patient-level data for iterative improvement in outcomes. Furthermore, because tracheostomy is associated with exceptionally high expenditure, reducing complications and length of stay dramatically improves value. Furthermore, focus interviews demonstrated improved morale for the care team, thereby realizing all goals of the quadruple aim.