title: The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost.
abstract: Ward decannulation is the eventual endpoint for the majority of the 40 children managed by tracheostomy at Great Ormond Street Hospital each year. Our previous protocol dictated a 10 day stay in hospital for the 25 children decannulated annually. The aim of this retrospective study was to determine the minimum safe duration for this inpatient stay. In addition, we hoped to identify any factors which might distinguish potentially successful candidates from those likely to fail decannulation. Of 104 patients decannulated between January 1991 and January 1996, complete nursing and medical records were retrieved for 84 children. These notes were retrospectively reviewed and in this group of patients there were 101 attempted decannulations. Information about the initial pathology, interim course and details of the decannulation were collected. Summary statistics were generated. There was no relation between initial pathology or duration of tracheostomy and eventual success or failure of decannulation. Observations by the nursing staff of restlessness, anxiety and recession appeared more frequently in children who eventually failed decannulation. All failures occurred within 48 h of the 24 h trial of tracheostomy blocking. Our results suggest that a safe decannulation protocol can allow discharge after day five.
authors.affiliation: Department of Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Waddell
authors.forename: R
authors.initials: R
authors.lastname: Appleford
authors.forename: C
authors.initials: C
authors.lastname: Dunning
authors.forename: B C
authors.initials: BC
authors.lastname: Papsin
authors.forename: C M
authors.initials: CM
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D014139:Tracheostomy