Patient Safety/Quality Improvement TheTrach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration Otolaryngology– Head and Neck Surgery 1–12 Ó American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599820917427 http://otojournal.org Rebecca L. Cherney 1,2 , Vinciya Pandian, PhD, MBA, MSN 3 , Ashly Ninan 1,3 , Debra Eastman, MSN 1 , Brian Barnes 1 , Elizabeth King 1 , Brianne Miller 1 , Samantha Judkins 1 , Alfred E. Smith IV 4 , Nan M. Smith 4 , Julie Hanley, MSN 1 , Eileen Creutz 1 , Megan Carlson, MS, CCC-SLP 1 , Kevin J. Schneider, MA 5 , Leah L. Shever, PhD 1,2 , Keith A. Casper, MD 5 , Patricia M. Davidson, PhD 3 , and Michael J. Brenner, MD 4,5 Abstract Objective. To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods. The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchro- nous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and out- comes. Trach Trail, a standardized care pathway, was devel- oped with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didac- tics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demo- graphics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a syn- chronous tracheostomy control group (n = 117). Results. Fifty-five nurses completed Trach Trail training, pro- viding care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P \ .05). The incidence of adverse events was unchanged. Discussion. Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice. Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes. Keywords PS/QI, patient safety, quality improvement, tracheostomy, multidisciplinary team, length of stay, airway, nursing, respi- ratory therapy, speech-language pathology, intensive care unit, simulation, patient-centered care, interdisciplinary col- laboration, LOS, adverse events Received October 3, 2019; accepted February 15, 2020. T he indications for tracheostomy include acute respiratory failure, airway protection, head and neck reconstruction, and need for prolonged ventilation. 1,2 1 University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA 2 University of Michigan School of Nursing, Ann Arbor, Michigan, USA 3 Johns Hopkins School of Nursing, Baltimore, Maryland, USA 4 Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA 5 Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA This article was presented as a poster at the Fifth International Tracheostomy Symposium, October 2019, Melbourne, Australia, and at the podium of the AAO-HNSF Annual Meeting & OTO Experience; September 2019, New Orleans, Louisiana. Corresponding Author: Michael J. Brenner, MD, Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive, SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA. Email: mbren@med.umich.edu