Objectives: We aimed to characterise the use of tracheostomy procedures for all COVID-19 critical care patients in England and to understand how patient factors and timing of tracheostomy affected outcomes. Design: A retrospective observational study using exploratory analysis of hospital administrative data. Setting: All 500 National Health Service hospitals in England. Participants: All hospitalised COVID-19 patients aged ≥ 18 years in England between March 1st and October 31st, 2020 were included. Main outcomes and measures: This was a retrospective exploratory analysis using the Hospital Episode Statistics administrative dataset. Multilevel modelling was used to explore the relationship between demographic factors, comorbidity and use of tracheostomy and the association between tracheostomy use, tracheostomy timing and the outcomes. Results: In total, 2,200 hospitalised COVID-19 patients had a tracheostomy. Tracheostomy utilisation varied substantially across the study period, peaking in April-June 2020. In multivariable modelling, for those admitted to critical care, tracheostomy was most common in those aged 40-79 years, in males and in people of Black and Asian ethnic groups and those with a history of cerebrovascular disease. In critical care patients, tracheostomy was associated with lower odds of mortality (OR: 0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR: 41.143 (95% CI 30.979 to 54.642). In patients that survived, earlier timing of tracheostomy (≤ 14 days post admission to critical care) was significantly associated with shorter length of stay. Conclusions: Tracheostomy is safe and advantageous for critical care COVID-19 patients. Early tracheostomy may be associated with better outcomes, such as shorter length of stay, compared to late tracheostomy.

Rationale, aims and objectives: The Getting It Right First Time (GIRFT) programme was set up to reduce unwarranted variation in healthcare practice and outcomes in England. The aim of this study was to investigate early changes in practice in urology based on the recommendations made. Key recommendations included: 1) to increase rates of day-case surgery for transurethral resection of bladder tumour (TURBT), 2) to reduce use of stenting as a primary procedure for emergency presentations with ureteric stones and 3) to reduce waiting times for male bladder outflow tract surgery following emergency presentation with urinary retention. Methods: Data on patient age, the treatment provider, dates of admission and discharge, diagnoses and procedures conducted were extracted from the Hospital Episodes Statistics database from January 2014 to December 2019. The dates of visits by members of the GIRFT team was taken as the intervention point. Interrupted time series analysis was used to identify trends pre- and post-intervention. Results: There was evidence of a significant increase in the proportion of patients seen as day-cases for TURBT and decreased use of stents and increased use of ureteroscopy or extracorporeal shock-wave lithotripsy on first presentation with ureteric stones following GIRFT visits. However, there was no significant change in waiting times for surgery to treat patients who had an emergency presentation with urinary retention. Conclusions: In the first 18 months following the last of the GIRFT visits, there is some evidence that the recommendations made are already having an impact on clinical practice. The reasons why some recommendation appear to be harder to implement requires further investigation.