Tracheostomy management in acute care facilities--a matter of teamwork.

AIM

Implement and evaluate an inter-disciplinary team approach to tracheostomy management in non-critical care.

BACKGROUND

Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient's destination after ICU.

DESIGN

A mixed method evaluation incorporating quantitative and qualitative approaches.

METHOD

Data collection included pre-implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis.

RESULTS

Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50-27 days (p < 0.0001) and an increase in the number of tracheostomy patients transferred to non-critical care wards in the postgroup (p = 0.006). The number of wards accepting patients from ICU increased from 3-7 and there was increased staff knowledge, confidence and awareness of the team's role.

CONCLUSION

The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of inter-disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter-disciplinary practice, supported by communication and data management that can be replicated across other patient groups.