• R Cetto, A Arora, R Hettige, M Nel, L Benjamin, C M H Gomez, W L G Oldfield, and A A Narula.
• Department of Otorhinolaryngology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. raul.cetto10@imperial.ac.uk
• Clin Otolaryngol. 2011 Oct 1;36(5):482-8.

ObjectivesSuboptimal standards in tracheostomy care have been highlighted as a growing concern in view of the increasing demands for intensive care services. Our objective is to assess the impact of our model for tracheostomy care on patients with short-term tracheostomies (<4 months in situ) following their discharge from the intensive care unit. The model has three components: The St Mary's tracheostomy care bundle checklist, a dedicated tracheostomy multidisciplinary team and an educational programme.DesignA 38-month prospective cohort study.SettingA London Teaching Hospital.ParticipantsA total of 102 patients with tracheostomy within the 19-month pre-intervention cohort and 95 patients in the 19-month post-intervention cohort.Main Outcome MeasuresThe number of clinical incidents, mean time taken for decannulation, mean total tracheostomy time and total number of days spent in the intensive care unit were assessed before and after the intervention.ResultsTime to decannulation following intensive care unit discharge decreased from 21 to 11 days, as did the mean total tracheostomy time, from 34 to 25 days (both statistically significant with a P < 0.0001 Mann-Whitney U-test). The number of critical incidents, which included all patients prior to exclusion, substantially declined following the introduction of intervention from 58 to 7 in the second year after intervention.ConclusionsA multidisciplinary care model significantly expedited the decannulation process and reduced the overall time that a tracheostomy was in situ. The intervention was associated with a reduction in clinical incidents and shorter intensive care unit admissions, which can be associated with significant monetary savings.© 2011 Blackwell Publishing Ltd.

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