The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts


Sally Paluck RRCP, Rosemary Martino M.Sc., MA, S-LP(C), Mary Ann Neary M.Sc., S-LP(C), Sandra Grgas RRCP, Elana Aziza M.H.Sc., S-LP(C), John T. Granton MD University Health Network, Toronto Canada

Background: A tracheotomy is commonly performed in critically ill patients to facilitate weaning, suctioning and potentially reduce upper airway injury. Once the primary respiratory problem is corrected, the challenge is then to move the patient towards decannulation in a timely manner and without complications. Patients with tracheotomies provide challenges to discharge from the acute hospital since many institutions will not accept this more complex patient. The decision process on how and when to decannulate tracheotomized patients requires expertise from several health professionals. A multidisciplinary Tracheostomy Team was formalized in 1997 at our tertiary acute care facility with representatives from Nursing, Respiratory Therapy, and Speech-Language Pathology. Over time this Team has become more cohesive and systematic in its approach with weekly rounds and data forms that facilitate and record joint decisions regarding individualized management for inpatients with tracheotomies.

Methods: This research is a descriptive and empirical analysis of the prospectively weekly-collected outcome data for all tracheotomized in-patients seen by the Team from 1997 to 2001. Data on 227 patients who received temporary tracheotomy tubes were compared in one-year intervals from 1997-2001. The primary outcomes for comparison were length of acute hospital stay and cannulation time. The secondary outcomes for comparison were time to cuff deflation, time to first tracheostomy change, time to corking, time to suture removal, mortality, and discharge disposition. Patient age, gender, nursing unit at time of tracheotomy insertion, height, weight, most responsible admitting diagnosis, tracheotomy type, reason for tracheotomy, Glasgow Coma Score at admission, Glasgow Coma Score at the first and last tracheotomy day, number and type of in-patient surgical procedures, and number and type of in-patient diagnosis were compared at baseline to ensure similarity.

Results: Preliminary results from initial descriptive analyses show a positive influence on patient outcome with Team intervention. Specifically, there is an overall trend toward reducing mean length of acute hospital stay and cannulation time.

Outcomes in Insertion
mean days (SD)
Year of Tracheotomy
1997 1998 1999 2000 2001
Hospital stay 97.1 (71.0) 96.6 (69.0) 108.5 (130.0) 112.2 (90.6) 64.0 (55.2)
Cannulation 59.0 (40.1) 54.3 (31.4) 64.8 (70.9) 51.9 (32.6) 43.8 (22.9)
Cuff deflation 27.2 (22.0) 18.8 (11.2) 19.6 (12.4) 16.2 (6.9) 27.3 (20.9)
Time to corking 42.2 (27.5) 39.3 (27.5) 33.2 (21.6) 29.1 (13.7) 47.1 (36.1)

Discussion: Although the overall trend was a reduction in time measures, there was a period in 1999 and 2000 where the primary time outcomes increased. This may have occurred due to a temporary decrease in Team involvement on certain units. Team involvement in these units resumed in the latter part of the year 2000 and the outcomes once again appear to resume the positive trend of time reduction in year 2001. Inferential analysis will be completed and results presented in yearly intervals along with a discussion of possible confounding factors. The majority of these outcome data are either interval (i.e. time in days) or nominal (i.e. discharge disposition), therefore distributions will be tested for normality and then ANOVA will be performed to compare multiple yearly time periods.

Conclusion: This preliminary data suggests benefits from a cohesive and structured team approach to the care of in- patients with tracheotomy tubes. The benefit of reducing cannulation time will likely influence a decrease in cost of service provision along with an increase in overall patient quality of life.