1995 OPEN FORUM Abstracts
TRACH TEAM: A MULTIDISCIPLINARY APPROACH TO MANAGING TRACHEOSTOMIES IN A UNIVERSITY TEACHING HOSPITAL AND TRAUMA CENTER.
CL Kasper RRT, CR Stubbs RRT, JA Barton, DJ Pierson MD, Harborview Medical Center, Seattle WA.
Introduction/Background. During a 1-yr observational period, we previously demonstrated (Respir Care 1994;39:1110) that pts who underwent tracheotomy at our institution, or were admitted with a trach, comprised a heterogeneous group in terms of admitting diagnosis, managing service, need for respiratory care, and outcome. This study tested the hypothesis that an organized, multidisciplinary approach to assessment and management in pts with trachs would have a measurable impact on the care of these pts in our hospital. Materials and methods. At the conclusion of the observational period (Y1, 7/92-6/93) we formed a trach team, comprised of RCPs and speech pathologists, with the medical director of RC and an OTO/H&N surgeon available for consultation, and also developed protocols for trach management and decannulation, which were reviewed and approved by the chiefs of all medical services as well as nursing management. The trach team rounded on every trached pt once each week. We reviewed the charts of all pts with trachs for 1 yr following formation of the team (Y2, 7/93-6/94), and compared the results with those from Y1. Results. The numbers of trach pts (112) and admissions (152) available for review were similar to the previous year's, as were pt demographics (mean age 39 yr, 68% males). Somewhat more pts were admitted because of trauma, and to the general surgery and neurosurgery services, than in Y1, and more pts were ventilated on admission. However, hospital mortality (7%), length of stay (mean 39 days, range 10-86), and the incidences of ARDS (9%) and hospital-acquired pneumonia (36%) were the same in Y2 and Y1. More pts had progress notes by RCPs in Y2 (96% vs 69%, p = 0.000). The trach team made recommendations in 2/3 of pts with trachs during Y2, and these were followed by the primary team 87% of the time. More pts had trach tubes changed during Y2 (69% vs 52%, p = 0.005); although the initial tubes used were the same in Y2 & Y1, in Y2 more pts were switched to double-cannula tubes (p = 0.000), especially those with pre-existing trachs on admission. The number of pts decannulated was the same both years (30% Y2 vs 22% Y1, p = 0.126). Conclusions. In our university teaching hospital and trauma center, institution of a multidisciplinary trach team resulted in improved patient care.