RT Journal Article
SR Electronic
T1 Tracheostomy Team Initiative to Facilitate Early Tracheostomy and Decrease Trach to Discharge
JF Respiratory Care
FD American Association for Respiratory Care
SP 3951220
VO 68
IS Suppl 10
A1 Chehreh, Paula M.
A1 Terrell, Ilsy
A1 Blake, Shane
A1 Graves, Jessica
A1 King, Christopher
YR 2023
UL http://rc.rcjournal.com/content/68/Suppl_10/3951220.abstract
AB Background: Tracheostomy patients can be time consuming and complex, resulting in increased length of stay and medical costs. Efficient care of these patients with an interdisciplinary team has been attempted with some positive results regarding the decreased hospital length of stay and overall costs. We sought to determine the effects of our institution’s multidisciplinary tracheostomy team on time to tracheostomy, time from tracheostomy to discharge and discharge destination. Methods: Data was collected from adult patients undergoing tracheostomy in 2019 and 2022 at Inova Fairfax Medical Center. We elected to focus on the year 2019 as it was prior to the COVID-19 pandemic and institution of a tracheostomy team at our facility. The multidisciplinary tracheostomy team proactively tracked patients with prolonged duration of mechanical ventilation and actively contacted ICU teams regarding consideration of tracheostomy. Additionally, an electronic best-practice alert was sent to providers of patients with prolonged invasive mechanical ventilation (> x days). Total number of trachs performed, time from admit to tracheostomy, and percentage of patients discharged home were determined. The tracheostomy team provided tracheostomy care to include suture removal, tracheostomy change, downsizing and discharge education. Results: In 2019, 111 tracheostomies were performed with a mean and median time to tracheostomy of 14.3 and 12 days respectively. Number of tracheostomies increased to 195 in 2022 with a mean and median time to tracheostomy of 12.1 and 11 days, respectively. The time from tracheostomy to discharge in 2019 was a mean of 19.6 days and median of 15 days, as compared to 29.1 days mean and 21 days median in 2022. The percentage of patients discharged to home did not decrease from 2019 (n = 33, 29.7%) to 2022 (n = 33, 16.9%). Conclusions: Institution of a multidisciplinary tracheostomy team was associated with a decrease in the time to tracheostomy at our institution. A decrease in time from tracheostomy to discharge or percentage of patients discharged home was not realized; however, this may be due to increased patient acuity from year 2019 to 2022. Further study into the salutary effects of a multidisciplinary tracheostomy team is warranted, including data collection of tracheostomy complications including deep tissue injury, local wound infection and ventilator associated pneumonia, as well as survey data on patient and family satisfaction and comfort with tracheostomy care.