• Frederik Mondrup, Karen Skjelsager, and Kristian Rørbæk Madsen.
• Anæstesiologisk Afdeling, Næstved Sygehus, 4700 Næstved, Denmark. frederik.mondrup@gmail.com
• Dan Med J. 2012 Aug 1;59(8):A4481.

IntroductionWhen patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the ward.Material And MethodsWe performed an electronic questionnaire survey among heads of unit at registered Danish ICUs.ResultsA total of 34 out of 43 ICUs responded. 56% of the ICUs do not document individual plans for decannulation in the patient's chart. 91% of the ICUs do not perform daily follow-up of tracheotomised patients on the ward. No guidelines for decannulation on the ward were found, and only 6% have a guideline for accidental decannulation. Furthermore, as little as 47% of the ICUs report any formalized education or training of staff nurses in the management of tracheotomised patients.ConclusionGuidelines relevant to patients discharged from Danish ICUs with a tracheal cannula in situ are scarce; few ICUs employ individualized plans for tracheostomy management and decannulation; there is largely no daily intensivist-led post-ICU follow-up, and formal staff education in tracheostomy management on the ward is scarce. Altogether these factors create a potential for adverse events and increased morbidity in this high-risk, high-cost patient population. Possibly individualized plans for tracheotomised patients as well as intensivist-led follow-up on the ward can improve patient outcome and safety and this should be confirmed in a future study.Fundingnot relevant.Trial Registrationnot relevant.

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