The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

QUALITY IMPROVEMENT IN POST-TRACHEOTOMY PATIENT CARE LEADS TO INCREASED DECANNULATIONS

Brenda L. Graham, RRT, Paul F. Nuccio, RRT, FAARC, Michael R. Jackson, RRT-NPS CPFT, Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts.

Background: Advances in critical care and resuscitation have resulted in a growing number of patients who require prolonged ventilatory support. For those patients, a tracheotomy is usually performed.  Once a patient's critical care issues are resolved, many can be managed outside of an intensive care unit (ICU), on a designated step-down ward or in a rehabilitation facility.  Specialist outreach teams have been associated with shorter time to downsizing and decannulation. At a 755-bed academic medical center, variability in the management of post-tracheotomy patients prompted a need for quality improvement.

Hypothesis:  A formal, multidisciplinary trach care plan can lead to increased numbers of patients who are decannulated while still in the acute care institution.

Method: Over a six-month post-intervention ("after") period, one respiratory therapist conducted daily surveys of all inpatients that had received a tracheotomy during that hospitalization. The purpose of the daily surveys was to assess for the potential of decannulation, as well as to gather additional data related to the care of those patients.  This information was compared with data that had been gathered over a six-month period pre-intervention ("before"). Population statistics for "before" & "after" patients were otherwise comparably similar.

Results: The pre-intervention data showed that a minimal number of patients (2) had been decannulated prior to discharge to home or a rehabilitation center.  During the first six months post-intervention, the number of decannulations increased significantly (18).  This represents an increase of 800% over the pre-intervention period (See figure 1).



Conclusion: We designed a simple multi-faceted intervention, consisting of a practice algorithm, standardized tracheostomy care progress note and daily follow-up by a respiratory therapist. Results  show an improvement in the care of the tracheotomy patient.  This leads to an increase in the number of patients who are decannulated prior to hospital discharge.

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