Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
Crit Care Med. 2012 Jun;40(6):1827-34. doi: 10.1097/CCM.0b013e31824e16af.
The frequency of bedside percutaneous tracheostomies is increasing in intensive care medicine, and both safety and efficiency of care are critical elements in continuing success of this procedure. Prioritizing patient safety, a tracheostomy team was created at our institution to provide bedside expertise in surgery, anesthesiology, respiratory, and technical support. This study was performed to evaluate the metrics of patient outcome, efficiency of care, and cost-benefit analysis of the multidisciplinary Johns Hopkins Percutaneous Tracheostomy Program.
A review was performed for patients who received tracheostomies in 2004, the year before the Johns Hopkins Percutaneous Tracheostomy Program was established, and those who received tracheostomies in 2008, the year following the program's establishment. Comparative outcomes were evaluated, including the efficiency of procedure and intensive care unit length of stay, complication rate including bleeding, hypoxia, loss of airway, and a financial cost-benefit analysis.
Single-center, major university hospital.
The sample consisted of 363 patients who received a tracheostomy in the years 2004 and 2008.
The number of percutaneous procedures increased from 59 of 126 tracheostomy patients in 2004, to 183 of 237 in 2008. There were significant decreases in the prevalence of procedural complications, particularly in the realm of airway injuries and physiologic disturbances. Regarding efficiency, the structured program reduced the time to tracheostomy and overall procedural time. The intensive care unit length of stay in nonpulmonary patients and improvement in intensive care unit and operating room back-fill efficiency contributed to an overall institutional financial benefit.
An institutionally subsidized, multi-disciplinary percutaneous tracheostomy program can improve the quality of care in a cost-effective manner by decreasing the incidence of tracheostomy complications and improving both the time to tracheostomy, duration of procedure, and postprocedural intensive care unit stay.
在重症监护医学中，床边经皮气管切开术的频率不断增加，护理的安全性和效率是该手术持续成功的关键因素。为了优先保障患者安全，我们医院成立了一个气管切开术团队，提供手术、麻醉、呼吸和技术支持方面的专业知识。本研究旨在评估多学科约翰霍普金斯经皮气管切开术计划的患者转归、护理效率和成本效益分析的指标。
回顾了 2004 年（约翰霍普金斯经皮气管切开术计划成立前一年）接受气管切开术的患者和 2008 年（该计划成立后一年）接受气管切开术的患者。评估了包括程序效率和重症监护病房住院时间、并发症发生率（包括出血、缺氧、气道丧失）以及财务成本效益分析在内的比较结果。
单中心、大型大学医院。
样本包括 2004 年和 2008 年接受气管切开术的 363 名患者。
经皮手术数量从 2004 年 126 例气管切开术患者中的 59 例增加到 2008 年 237 例。手术并发症的发生率显著下降，特别是在气道损伤和生理紊乱方面。在效率方面，该结构化程序缩短了气管切开术的时间和整体手术时间。非肺部患者的重症监护病房住院时间缩短，以及重症监护病房和手术室的回补效率提高，为机构带来了整体经济效益。
机构资助的多学科经皮气管切开术计划可以通过降低气管切开术并发症的发生率，以及提高气管切开术的时间、手术持续时间和术后重症监护病房的住院时间，以具有成本效益的方式改善护理质量。
