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.