Chorney Stephen R, Brown Ashley F, Brooks Rebecca L, Bailey Candace, Whitney Cindy, Sewell Ashley, Johnson Romaine F
Children's Health Airway Management Program, Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
OTO Open. 2021 Sep 30;5(3):2473974X211045615. doi: 10.1177/2473974X211045615. eCollection 2021 Jul-Sep.
To analyze a multidisciplinary tracheostomy team's effect on length of stay and cost.
An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and caregiver education. Process measures included time to first education, speech-language pathology consultation rates, and pretracheostomy consultations. Outcome measures focused on the total length of stay, 30-day revisit rates after discharge, accidental decannulation rate, and standardized cost. Regression analysis was used to predict the program's effect on length of stay and total cost.
In total, 239 children met inclusion. The mean time to first education class was reduced from 13.7 to 1.9 days ( < .001). The speech-language pathology consultation rate increased from 68% to 95% ( < .001), and the presurgical consultation rate with the tracheostomy team increased from 14% to 93% ( < .001). The length of stay decreased from 133 to 96 days ( = .006). Total costs were lower for short admissions but higher for prolonged admissions. Revisits within 30 days remained stable over time (18%).
Establishing a multidisciplinary tracheostomy team results in improvements in quality metrics when caring for children with tracheostomies. Controlling for associated factors showed the mean length of stay decreased significantly in the first full year of program implementation. Cost analysis estimated significant reductions for tracheostomy patients spending less time in the hospital.
A airway management program can positively affect tracheostomy processes and outcomes.
分析多学科气管造口术团队对住院时间和费用的影响。
创建了一个使用平衡计分卡的气道管理项目，以跟踪关键绩效指标。干预措施包括每周查房、标准化置管、术后护理和护理人员教育。过程指标包括首次教育时间、言语病理学咨询率和气管造口术前咨询。结果指标侧重于总住院时间、出院后30天复诊率、意外脱管率和标准化费用。采用回归分析来预测该项目对住院时间和总成本的影响。
共有239名儿童符合纳入标准。首次教育课程的平均时间从13.7天减少到1.9天（P<0.001）。言语病理学咨询率从68%提高到95%（P<0.001），气管造口术团队的术前咨询率从14%提高到93%（P<0.001）。住院时间从133天减少到96天（P=0.006）。短期住院的总成本较低，但长期住院的总成本较高。30天内的复诊率随时间保持稳定（18%）。
建立多学科气管造口术团队可改善气管造口术儿童的护理质量指标。对相关因素进行控制后发现，在项目实施的第一个完整年度，平均住院时间显著缩短。成本分析估计，住院时间较短的气管造口术患者费用大幅降低。
气道管理项目可对气管造口术的过程和结果产生积极影响。
