Research and Practice Development, Hunter New England Area Health Service, John Hunter Hospital, Newcastle, NSW, Australia.
J Clin Nurs. 2010 May;19(9-10):1275-83. doi: 10.1111/j.1365-2702.2009.03155.x. Epub 2010 Mar 18.
Implement and evaluate an inter-disciplinary team approach to tracheostomy management in non-critical care.
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.
A mixed method evaluation incorporating quantitative and qualitative approaches.
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.
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.
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.
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.
在非重症监护病房实施并评估跨学科团队方法进行气管切开术管理。
重症监护病房（ICU）中早期气管切开术的趋势导致气管切开术患者数量增加。再加上 ICU 提前出院的压力，这给各学科和病房都带来了挑战。尽管气管切开术适用于各种患者群体，但气管切开术护理被视为重症监护专科临床医生的领域。无论患者在 ICU 后的去向如何，确保高质量的护理都至关重要。
采用定量和定性方法相结合的混合方法评估。
数据收集包括实施前和实施后的临床审核以及员工调查，以及实施后的气管切开术团队焦点小组。使用描述性和推断性分析来确定临床指标和员工经验的变化。使用主题分析的迭代过程对焦点小组数据进行分析。
研究结果表明，幸存者的平均住院时间（LOS）从 50 天缩短至 27 天（p < 0.0001），并且在后组中转移到非重症监护病房的气管切开术患者数量增加（p = 0.006）。接受 ICU 患者的病房数量从 3 个增加到 7 个，并且员工的知识、信心和对团队角色的认识有所提高。
该团队方法导致工作实践和患者结果的改善。团队得到了组织的认可，导致更多的病房表示愿意接受气管切开术患者。沟通的改善导致了更及时的转介和更好的患者结果。
本研究强调了跨学科团队合作在实现有效患者结果和效率方面的重要性。它提供了一种跨学科实践模式，以沟通和数据管理为支撑，可以在其他患者群体中复制。
