An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort studyReport as inadecuate




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Critical Care

, 12:R48

First Online: 11 April 2008Received: 01 December 2007Revised: 20 February 2008Accepted: 11 April 2008

Abstract

IntroductionWithout specific strategies to address tracheostomy care on the wards, patients discharged from the intensive care unit ICU with a tracheostomy may receive suboptimal care. We formed an intensivist-led multidisciplinary team to oversee ward management of such patients. To evaluate the service, we compared outcomes for the first 3 years of the service with those in the year preceding the service.

MethodsData were prospectively collected over the course of 3 years on ICU patients not under the care of the ear, nose, and throat unit who were discharged to the ward with a tracheostomy and compared with outcomes in the year preceding the introduction of the service. Principal outcomes were decannulation time, length of stay after ICU discharge, and stay of less than 43 days upper trim point for the disease-related group DRG for tracheostomy. Analysis included trend by year and multivariable analysis using a Cox proportional hazards model. P values of less than 0.05 were assumed to indicate statistical significance. As this was a quality assurance project, ethics approval was not required.

ResultsTwo hundred eighty patients were discharged with a tracheostomy over the course of a 4-year period: 41 in 2003, 60 in 2004, 95 in 2005, and 84 in 2006. Mean age was 61.8 13.1 years, 176 62.9% were male, and mean APACHE Acute Physiology and Chronic Health Evaluation II score was 20.4 6.4. Length of stay after ICU decreased over time 30 13 to 52 versus 19 10 to 34 days; P < 0.05 for trend, and a higher proportion of decannulated patients were discharged under the upper DRG trim point of 43 days 48% versus 66%; P < 0.05. Time to decannulation after ICU discharge decreased 14 7 to 31 versus 7 3 to 17 days; P < 0.01 for trend. Multivariate analysis showed that the hazard for decannulation increased by 24% 3% to 49% per year.

ConclusionAn intensivist-led tracheostomy team is associated with shorter decannulation time and length of stay which may result in financial savings for institutions.

AbbreviationsAPACHE II= Acute Physiology and Chronic Health Evaluation II

DRG= disease-related group

ENT= ear, nose, and throat

ICU= intensive care unit

MET= medical emergency team.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6864 contains supplementary material, which is available to authorized users.

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Author: Antony E Tobin - John D Santamaria

Source: https://link.springer.com/







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