The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

IMPACT OF AN ALGORITHM ON TRACHEOSTOMY PLACEMENT POST- OPEN HEART SURGERY

John J. Hill, RRT-PNS; Charlotte Sims, CRT; Joseph Bestic, CRT; Respiratory Care Staff; Robert Bender, DO; Raymond Wargovich, MD; Michael J. Neary, MD; David M. Murphy, MD, Department of Surgery; Gail Anolik, RN, PhD; Michelle Goffney, MSW,LCSW; Lynn B. McGrath, MD, DEBORAH Heart & Lung Center, Browns Mills, New Jersey.

BACKGROUND: The insertion of a tracheostomy tube is always a challenging decision for patients who fail to wean from mechanical ventilation following open heart surgery (OHS). Caregivers and family expectations are often quite varied. This project details the process improvement project, through utilization of an algorithm, to promote standardizing the timing of tracheostomy placement. The purpose of this project is to assess the impact that a developed pathway has on the initiation of tracheostomy from endotracheal tube liberation.

METHODS: An interdisciplinary team that included Respiratory Care, Physicians, Department of Surgery, Nursing, and Case Management developed a collaborative algorithm to standardize the pathway for timing of tracheostomy after open heart surgery for patients requiring prolonged mechanical ventilation.

RESULTS: Between January 2003 through March 2005, 78 patients required tracheostomy for ventilator dependent respiratory failure prior to discharge after OHS. Before launching the algorithm, the mean interval for timing of tracheostomy after OHS was 19 days (n= 44 pts; Mdn 19.5 days, SD 6.1 days). The mean interval for timing of tracheostomy after initiation of algorithm was 14.09 days (n= 34 pts; Mdn 12.5 days, SD 7.8 days). Comparison of the pre- algorithm and post-algorithm intervals yielded a significant difference in mean interval between OHS and tracheostomy placement in the post-algorithm group (p=.003).Trend line indicates less variability in the post-algorithm group, although there was one outlier month which impacted the standard deviation calculation.

CONCLUSION: Use of an interdisciplinary driven algorithm to support standardizing the timing of tracheostomy after OHS is an effective process improvement strategy. Its use promoted family involvement in decision-making and interdisciplinary communication to support flow of care.

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