PURPOSE: To evaluate the impact of inter-disciplinary team approach on hospital stay and discharges of non critical care tracheostomized patients.
METHODS: Insertion of percutaneous tracheostomy (PCT) in intensive care units (ICU), has improved the safety of early ICU discharges. However the continuation of care of these patients is not well organized, which delays the hospital discharges. As a hospital quality project Tracheostomy Care Task Force was developed in our hospital, which includes intensivist, respiratory therapist and charge nurse of the ward. Retrospectively 6 months pre implementation and prospectively 6 months data was collected from neurosurgical unit. Collected data includes indication and duration of tracheostomy, reasons for the failure of weaning, Glasgow Coma Scale (GCS) at the time of decannulation, hospital stay before and after decannulation and hospital mortality.
RESULTS: Pre implementation and post implementation data was collected between January to December 2009. Total of 44 and 47 patients with PCT were identified in each group. The major indication for PCT was severe traumatic brain injury followed by spontaneous cerebral hemorrhage in both the groups. Mean days of tracheostomy before decannulation were 56 for pre implementation and 36 days for post implementation (p-value <0.05). 9(20%) patients in pre and 24(51%) in post implementation were decannulated (p-value <0.05). 3(7%) and 5(10%) patients were discharged with tracheostomy tube in each group respectively. 2(4%) patients in pre and 4(8%) in post implementation died with tracheostomy tube. 2(4%) patients in pre and one in post implementation group had subglottic stenosis and were not decannulated.Low GCS was the most common reason for weaning failure. Mean days from post decannulation to hospital discharge were 4 days in both pre and post implementation phase. None of the patient required readmission to ICU after decannulation.
CONCLUSION: Structured multidisciplinary tracheostomy care team was associated with significant reductions in hospital days, early and increase number of decannulations and hospital discharges. Mortality rates were unaffected.
CLINICAL IMPLICATIONS: Dedicated tracheostomy team can lead to early decannulation and hospital discharges.
DISCLOSURE: Jawed Abubaker, No Financial Disclosure Information; No Product/Research Disclosure Information