Welton Cynthia, Morrison Melissa, Catalig Marifel, Chris Juliana, Pataki Janos
Quality Department, Trillium Health Partners, Mississauga, Ontario.
Can J Respir Ther. 2016 Winter;52(1):7-11.
Percutaneous tracheostomy is a common procedure in the intensive care unit and, on patient transfer to the wards, there is a gap in ongoing tracheostomy management. There is some evidence that tracheostomy teams can shorten weaning to decannulation times. In response to lengthy weaning to decannulation times at Trillium Health Partners - Credit Valley Hospital site (Mississauga, Ontario), an interprofessional tracheostomy team, led by respiratory therapists and consisting of speech-language pathologists and intensive care physicians, was implemented.
To evaluate the interprofessional tracheostomy team and its impact on time from weaning off mechanical ventilation to decannulation; and time from weaning to speech-language pathology referral.
Performance metrics were collected retrospectively through chart review pre- and post-team implementation. The primary metrics evaluated were the time from weaning off mechanical ventilation to decannulation, and time to referral to speech-language pathology.
Following implementation of the interprofessional tracheostomy team, there was no improvement in decannulation times or time from weaning to speech-language pathology referral. A significant improvement was noted in the average time to first tracheostomy tube change (36.2 days to 22.9 days; P=0.01) and average time to speech-language pathology referral following initial tracheostomy insertion (51.8 days to 26.3 days; P=0.01).
An interprofessional tracheostomy team can improve the quality of tracheostomy care through earlier tracheostomy tube changes and swallowing assessment referrals. The lack of improved weaning to decannulation time was potentially due to poor adherence with established protocols as well as a change in mechanical ventilation practices. To validate the findings from this particular institution, a more rigorous quality improvement methodology should be considered in addition to strategies to improve protocol compliance.
经皮气管切开术在重症监护病房是一种常见的操作，而在患者转至病房后，气管切开术的持续管理存在空白。有证据表明，气管切开术团队可缩短撤机至拔管时间。针对翠菊健康伙伴 - 信贷谷医院院区（安大略省密西沙加）撤机至拔管时间过长的问题，组建了一支由呼吸治疗师牵头、言语病理学家和重症监护医师组成的跨专业气管切开术团队。
评估跨专业气管切开术团队及其对从机械通气撤机至拔管时间，以及从撤机至言语病理学转诊时间的影响。
通过回顾团队实施前后的病历，回顾性收集绩效指标。评估的主要指标是从机械通气撤机至拔管的时间，以及转诊至言语病理学的时间。
跨专业气管切开术团队实施后，拔管时间或从撤机至言语病理学转诊时间并无改善。首次气管切开套管更换的平均时间（从36.2天降至22.9天；P = 0.01）以及初次气管切开术后转诊至言语病理学的平均时间（从51.8天降至26.3天；P = 0.01）有显著改善。
跨专业气管切开术团队可通过更早的气管切开套管更换和吞咽评估转诊来提高气管切开术护理质量。撤机至拔管时间未改善可能是由于对既定方案的依从性差以及机械通气实践的改变。为验证该特定机构的研究结果，除了提高方案依从性的策略外，还应考虑采用更严格的质量改进方法。
