Results of applying a safety protocol of the patient with tracheotomy from a critical care unit
Abstract Introduction and objective: Increasing the number of tracheostomies in critical care units significantly increases morbimortality in the wards. To reverse this, we have implemented a multidisciplinary follow-up program based on training, standardization of care and the adoption of new strategies. Methodology: Prospective and observational cohort study of the follow-up of 150 patients in a third-level university hospital that does not have a step-down unit. We record and analyze the clinical and epidemiological variables and the evolution after the application of the program. Results: The average age was 61 years old, 67% male, and 41% neurocritical care patients. Percutaneous tracheostomy in 71% of all tracheostomies. Global mortality was 17% and that of patients with stroke was 6.3%. Readmission to critical care units was 8%. Low-severity complications were detected in 23% of patients. The decannulation process was completed during admission in 43% of patients, 38% in all discharged from hospital, 55% of them with oral feeding now of discharge. Average stay in critical care unit was 34 days and hospital length of stay was 70 days. Conclusions: This work describes the results obtained after applying a multidisciplinary follow-up protocol in the wards, of the tracheotomized patient who comes from the critical care units. The purpose of this follow-up is to improve the safety of these patients, to reduce their morbimortality. The application of new strategies will allow their evaluation in relation to the data obtained from this study.
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Paul F. Tracheostomy care and management in general wards and community settings: literatura review. Nurs Crit Care. 2010;15:76-85. https://doi.org/10.1111/j.1478-5153.2010.00386.x
Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care. 2009;13:R177. https://doi.org/10.1186/cc8159
McGrath BA, Thomas AN. Patient safety incidents associated with tracheostomies occurring in hospital wards: a review of reports to the UK National Patient Safety Agency. Postgrad Med J. 2010;86:522-5. https://doi.org/10.1136/pgmj.2009.094706
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Cetto R, Arora A, Hettige R, Nel M, Benjamin L, Gomez CM, et al. Improving tracheostomy care: a prospective study of the multidisciplinary approach. Clin Otolaryngol. 2011;36:482-8. https://doi.org/10.1111/j.1749-4486.2011.02379.x
Bedwell JR, Pandian V, Roberson DW, McGrath BA, Cameron TS, Brenner MJ. Multidisciplinary Tracheostomy Care: How Collaboratives Drive Quality Improvement. Otolaryngol Clin North Am. 2019;52:135-47. https://doi.org/10.1016/j.otc.2018.08.006
Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125:e104-e118. https://doi.org/10.1016/j.bja.2020.04.054
Mah JW, Staff II, Fisher SR, Butler KL. Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care. Respir Care. 2017;62:137-43. https://doi.org/10.4187/respcare.04878
Medeiros GC, Sassi FC, Lirani-Silva C, Andrade CRF. Criteria for tracheostomy decannulation: literature review. Codas. 2019;31:e20180228. https://doi.org/10.1590/2317-1782/20192018228
Gandía-Martínez F, Martínez-Gil I, Andaluz-Ojeda D, Bobillo de Lamo F, Parra-Morais L, Díez-Gutiérrez F. Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos. Neurocirugia (Astur). 2010;21:211-21. PMID: 20571724
Wilkinson KA, Freeth H, Martin IC. Are we 'on the right trach?' The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care. J Laryngol Otol. 2015;129:212-6. https://doi.org/10.1017/S0022215115000158
Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc. 2017;10:391-8. https://doi.org/10.2147/JMDH.S118419
Simpson TP, Day CJ, Jewkes CF, Manara AR. The impact of percutaneous tracheostomy on intensive care unit practice and training. Anaesthesia. 1999;54:186-9. https://doi.org/10.1046/j.1365-2044.1999.00667.x
Mondrup F, Skjelsager K, Madsen KR. Inadequate follow-up after tracheostomy and intensive care. Dan Med J. 2012;59:A4481. PMID: 22849980
Paul F. Tracheostomy care and management in general wards and community settings: literatura review. Nurs Crit Care. 2010;15:76-85. https://doi.org/10.1111/j.1478-5153.2010.00386.x
Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care. 2009;13:R177. https://doi.org/10.1186/cc8159
McGrath BA, Thomas AN. Patient safety incidents associated with tracheostomies occurring in hospital wards: a review of reports to the UK National Patient Safety Agency. Postgrad Med J. 2010;86:522-5. https://doi.org/10.1136/pgmj.2009.094706
McGrath BA, Wallace S, Lynch J, Bonvento B, Coe B, Owen A, et al. Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. Br J Anaesth. 2020;125:e119-e129. https://doi.org/10.1016/j.bja.2020.04.064.PMID: 32493580
Gerber DR, Chaaya A, Schorr CA, Markley D, Abouzgheib W. Can outcomes of intensive care unit patients undergoing tracheostomy be predicted? Respir Care. 2009;54:1653-7. PMID: 19961630
Pandian V, Miller CR, Mirski MA, Schiavi AJ, Morad AH, Vaswani RS, et al. Multidisciplinary team approach in the management of tracheostomy patients. Otolaryngol Head Neck Surg. 2012;147:684-91. https://doi.org/10.1177/0194599812449995
Tobin AE, Santamaria JD. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Crit Care. 2008;12:R48. https://doi.org/10.1186/cc6864
Speed L, Harding KE. Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis. J Crit Care. 2013;28:216.e1-10. https://doi.org/10.1016/j.jcrc.2012.05.005
de Mestral C, Iqbal S, Fong N, LeBlanc J, Fata P, Razek T, et al. Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. Can J Surg. 2011;54:167-72. https://doi.org/10.1503/cjs.043209
Norwood MG, Spiers P, Bailiss J, Sayers RD. Evaluation of the role of a specialist tracheostomy service: from critical care to outreach and beyond. Postgrad Med J. 2004;80:478-80. https://doi.org/10.1136/pgmj.2003.016956
Mirski MA, Pandian V, Bhatti N, Haut E, Feller-Kopman D, Morad A, et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med. 2012;40:1827-34. https://doi.org/10.1097/CCM.0b013e31824e16af
Álvaro-Matel B, Bejar-Espín L, Blaya-Sánchez Y, Blázquez-Soto JA, Calderón-García M, Calero-Márquez JB, et al. Atención integral al paciente portador de cánula. Consejería de Sanidad y Política Social. Servicio Murciano de Salud. Dirección de Enfermería del Complejo Hospitalario de Santa Lucía. Área II de Salud. Cartagena. Murcia. AIPPC 2016 [consultado 29 agosto 2021]. Disponible en: https://sms.carm.es/ricsmur/handle/123456789/367
Casasola-Girón M, Benito-Orejas J, Bobillo-de-Lamo F, Parra-Morais L, Cicuéndez-Ávila R, Morais-Pérez D. Proyecto de seguridad del paciente traqueotomizado procedente de una unidad de cuidados críticos. Revista ORL [Internet]. 7 Oct 2017 [citado 5 Ene 2018]; 0(0): 13p. Disponible en: http://revistas.usal.es/cinco/index.php/2444-7986/article/view/16932
Cetto R, Arora A, Hettige R, Nel M, Benjamin L, Gomez CM, et al. Improving tracheostomy care: a prospective study of the multidisciplinary approach. Clin Otolaryngol. 2011;36:482-8. https://doi.org/10.1111/j.1749-4486.2011.02379.x
Bedwell JR, Pandian V, Roberson DW, McGrath BA, Cameron TS, Brenner MJ. Multidisciplinary Tracheostomy Care: How Collaboratives Drive Quality Improvement. Otolaryngol Clin North Am. 2019;52:135-47. https://doi.org/10.1016/j.otc.2018.08.006
Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125:e104-e118. https://doi.org/10.1016/j.bja.2020.04.054
Mah JW, Staff II, Fisher SR, Butler KL. Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care. Respir Care. 2017;62:137-43. https://doi.org/10.4187/respcare.04878
Medeiros GC, Sassi FC, Lirani-Silva C, Andrade CRF. Criteria for tracheostomy decannulation: literature review. Codas. 2019;31:e20180228. https://doi.org/10.1590/2317-1782/20192018228
Gandía-Martínez F, Martínez-Gil I, Andaluz-Ojeda D, Bobillo de Lamo F, Parra-Morais L, Díez-Gutiérrez F. Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos. Neurocirugia (Astur). 2010;21:211-21. PMID: 20571724
Wilkinson KA, Freeth H, Martin IC. Are we 'on the right trach?' The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care. J Laryngol Otol. 2015;129:212-6. https://doi.org/10.1017/S0022215115000158
Benito-Orejas, J. I., Parra-Morais, L. ., Casasola-Girón, M., Cicuéndez-Ávila, R., Morais-Pérez, D., & Muñoz-Moreno, M. F. . (2022). Results of applying a safety protocol of the patient with tracheotomy from a critical care unit. Revista ORL, 13(3), e28030. https://doi.org/10.14201/orl.28030
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