The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

IMPROVED QUALITY OF CARE WITH STANDARDIZED TRACHEOSTOMY MANAGEMENT PROTOCOLS

L. S. Lenz1, C. Schneller1, S. Ruetlinger1, B. Sieck1, D. Tobert1, D. Hartman1, R. Kansteiner1


Background: Four different surgical groups place tracheostomy tubes at Gundersen Lutheran. Prior to the development of protocols, each surgeon used individualized methods for postoperative management. Variation in physician practice led to multiple patient management issues including conflicting orders, varied weaning techniques, large supply inventory, staff confusion, inconsistent patient education, and poor discharge planning. It was hypothesized that the implementation of standardized protocols by specially trained respiratory therapists would improve patient care by eliminating variances and developing staff expertise. It was also thought that consistent patient management would lead to earlier decannulation and decreased length of stay. In May 2004 a multidisciplinary team developed comprehensive protocols to address all aspects of tracheostomy management including routine care and cleaning, change intervals, swallowing assessment, trach type to facilitate speech and swallowing, speaking valves, decannulation criteria, as well as patient and family education. The four surgical departments, pulmonary medicine, and speech pathology approved the protocols.

Methods: Pre-protocol implementation data was gathered for a six-month period through retrospective chart review. Pre-protocol patients (n=25) were divided into the following categories: 1) trached and decannulated during hospital stay, 2) admitted with trach, 3) discharged with trach and 4) expired. Post-protocol data was gathered by respiratory therapists comprising the trach management team. Post-protocol patients (n=44) were divided in the same method as pre-protocol patients. Patients in the first category were evaluated for length of time the trach was in place (trach days) and length of stay (LOS). Table 1 shows the category breakdown of each group.

Results: Because the data were not normal, a non-parametric permutation test, 5000 repetitions, was used to compare groups. This test reflected a significant reduction in post-protocol trach days (mean=21) from pre-protocol trach days (mean=32)(p=0.029). There was no statistical difference in LOS with pre and post protocol means of 48 and 38 days respectively (p=0.10).

Conclusions: Comprehensive trach management protocols significantly reduced cannulation time. A larger sample size and continued data collection is necessary to assess whether or not the protocols will lead to a significant difference in LOS and other variables such as supply costs.

Table 1
  Pre-Protocol Post-Protocol
Trach and Decannulated 12 21
Admitted with Trach 5 10
Discharged with Trach 5 9
Expired 2 4
Total 25 44



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