Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients

• Published in: Canadian Journal of Surgery 2011-06, Vol.54 (3), p.167-172
• Main Authors: de Mestral, Charles, MD, Iqbal, Sameena, MD, MSc, Fong, Nancy, RT, LeBlanc, Joanne, SLP, Fata, Paola, MD, MSc, Razek, Tarek, MD, Khwaja, Kosar, MD, MSc
• Format: Article
• Language: English
• Subjects: Adult; Aged; Canada; Critical Care - methods; Critical Illness; Device Removal; Equipment and supplies; Female; Hospitals, Teaching; Humans; Intensive care; Intensive Care Units; Interdisciplinary Communication; Male; Methods; Middle Aged; Patient Care Team; Patient outcomes; Respiratory therapy; Retrospective Studies; Speech; Speech Therapy - instrumentation; Studies; Surgery; Terminal illnesses; Time Factors; Tracheostomy; Tracheostomy - adverse effects; Tracheostomy - instrumentation; Treatment Outcome
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.043209

Background A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward. Methods This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team. Results There were 32 patients in the preservice group and 54 patients in the post-service group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p < 0.001) after creation of the team. Furthermore, there appeared to be a decreased time to first tube downsizing (26.0 to 9.4 d) and decreased time to decannulation (50.4 to 28.4 d), although this did not reach statistical significance owing to our small sample size. Conclusion Standardized care provided by a specialized multidisciplinary tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve.