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.