in tracheostomy care
The members of the Global Tracheostomy Collaborative (GTC) assert that tracheostomy- related catastrophic events are like central
line-associated infections—they can be eliminated.
The GTC is working with health care providers,
hospitals, patients, and families around the globe to
make the vision of universal safe tracheostomy care
a reality. At present, 45 hospitals around the world
are members of the GTC, working to implement
key drivers that help eliminate adverse events while
tracking their outcomes in a worldwide database that
already houses more than 2,500 patient admissions.
Responding to frequent adverse events
Many studies show that tracheostomy-related adverse
events occur frequently (between 10 and 20 percent
of patients)—including preventable complications
that cause permanent injury or death.
who perform tracheostomies and provide care to
patients who require the procedure have, at some
point, encountered complications and, on occasion,
poor outcomes. Strikingly few of these adverse events
occur in the operating room. Catastrophic events
are particularly unfortunate because most involve
either the absence of preventive or rescue measures
that could easily have been in place, or training and
staffing deficits that could be readily eliminated.
As with central line-associated infections, it is not
enough to “spread the word” on these measures or
attempt to educate everyone on these processes. To
eliminate tracheostomy-related morbidity and mortality, each hospital should do the following: build a
robust system to ensure that clinical decision making
for “trach” patients is unified and consistent; implement simple preventative and rescue measures; and
ensure that staff trained in rescue measures are
always available at the bedside within 3 to 5 minutes of an emergency to intervene before permanent
hypoxic injury occurs.
The GTC was founded in July 2012, when the co-author of this article, David Roberson, MD, FACS,
FRCS, invited 20 tracheostomy and quality improvement experts from around the world to meet in
Glasgow, U.K. That group agreed to incorporate as
a not-for-profit organization and to create a program
that would disseminate best practices worldwide.
In the decade between 2000 and 2010, two
hospitals in very different locations and clinical
• Describes the GTC’s mission to disseminate
safe tracheostomy care worldwide
• Summarizes the five “key drivers” of
tracheostomy care improvement
• Discusses the benefits of implementing
team-based care and standard protocols