Tracheostomy Care Task Force for Noncritical Care Tracheostomized Patients
To determine the impact of an intensivist lead tracheostomy care team on the number of successful decannulations in non-critically ill patients and the time required for such decannulations and discharge from the hospital. Methods. Following the introduction of a multidisciplinary tracheostomy care task force, data was collected prospectively from July to December 2009. Matching control data was collected retrospectively from January to June 2009. Chi-Square and Mann-Whitney Utest were used to compare the differences in study variables with an α of 0.05. Results. A total of 44 and 47 patients with percutaneous tracheostomy (PCT) were discharged from the ICU pre- and post-implementation of the task force, respectively. Nine patients in pre- and 24 in postimplementation phase were decannulated, discharged from the hospital, and repatriated to their country of origin (Chi Sq. = 9.21, P = .002). Patients in pre-implementation group had longer hospital stay post ICU discharge compared to patients in post-implementation (58 vs. 34.1 days) group (PInsertion of percutaneous tracheostomy (PCT) has become a standard procedure usually performed by the intensivist on the critically ill patients. Post procedure, the tracheostomy care is mostly provided by the intensive care unit (ICU) nurses and ICU physicians. As there are no specialized tracheostomy teams available in many institutions, post ICU discharge the routine tracheostomy care is usually done by the ward nurses and respiratory therapist, without any close follow up by the operating team. This gap in continuity of care may lead to the delivery of suboptimal care to this group of patients. In most of the developed countries, there are both post-acute and long-term facilities, where such patients get optimum tracheostomy care and possible weaning and decannulation. In countries like United Arab Emirates (UAE) and especially in Dubai, where post-acute care facilities and rehabilitation centers are not available, most of these patients stay in an acute care facility until they are discharged. This further complicates the situation as the majority of these patients are non-United Arab Emirates (UAE) nationals, that is, they are expatriates and they need to be transferred back to their country of origin (repatriation). Thus, the discharge and repatriation process gets delayed further as the tracheostomized patients cannot be sent directly to their home in the country of origin and they have to be transferred to a hospital in their home place. Furthermore, for the safety of the patient and as per most of these commercial airlines policy, these tracheostomized patients need to be escorted with a nurse and a physician, which tremendously increases the cost of traveling, which has to be borne by the family of the patients.
Rashid Hospital Trauma Center is the largest 600-bed trauma and tertiary referral center of the United Arab Emirates, with an average emergency visit of 175,000– 200,000 per year. The Medical Intensive Care Unit has a capacity of 30 beds, which receives 900 to 1000 admissionsper year. A large number of patients admitted under trauma category have severe traumatic brain injury which is one of the common indications for admission to ICU. An average of approximately 80 to 100 patients per year require a tracheostomy and percutaneous tracheostomy is the preferred procedure in our ICU. Post ICU discharge, these tracheostomized patients are followed by the intensivist for a routine change of tracheostomy tube, which according to the hospital policy is 60 days from time of insertion or when the cuff or tube patency gets problematic. Beside a routine change of tracheostomy tube, the treating physician or the charge nurse along with respiratory therapist assess patients for weaning and decannulation screening criteria, as per weaning and decannulation protocol of Rashid Hospital (Figure 1). The respiratory therapist coordinates with intensivist to further assess patients for possible weaning and decannulation.
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Journal of Orthopedic and trauma.
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