Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team.
OBJECTIVE
To assess outcomes in patients with spinal cord injury (SCI) and a tracheostomy tube (TT), before and after the introduction of a tracheostomy review and management service (TRAMS) for ward-based patients.


METHODS
Matched-pairs design with two cohorts, before and after the intervention.


METHODS
900-bed tertiary hospital in Melbourne, Victoria.


METHODS
SCI patients with a TT that was removed: 34 patients in the post-TRAMS period (September 2003 to September 2006) were matched to 34 from the pre-TRAMS period (September 1999 to December 2001).


METHODS
TRAMS was introduced as a consultative team of specialist physicians, clinical nurse consultants, physiotherapists and speech pathologists. The team coordinated tracheostomy care, conducted twice-weekly rounds, and provided policy, education, and support.


METHODS
Comparison of length of stay (LOS), duration of cannulation (DOC), improved communication through use of a one-way valve, number of adverse events and related costs.


RESULTS
Median patient LOS decreased from 60 days (interquartile range [IQR], 38-106) to 41.5 days (IQR, 29- 62) (P = 0.03). The pre-TRAMS median DOC decreased from 22.5 days (IQR, 17-58) to 16.5 days (IQR, 12-25) (P = 0.08). Speaking-valve use increased from 35% (12/34) to 82% (28/34) (P < 0.01). Median time to a valve trial decreased from 22 days (IQR, 13-44) to 6 days (IQR, 4-10) after TT insertion (P < 0.01). There were two tracheostomy-related medical emergency calls pre-TRAMS and none post-TRAMS. There were no tracheostomy-related deaths in either group. The annual cost savings from implementing TRAMS were about eight times greater than the cost of service provision.


CONCLUSIONS
Implementing a tracheostomy review and management service improved outcomes for SCI patients: they left acute care sooner, spoke sooner, and the TT was removed earlier, with associated cost savings.
Cameron
Tanis S
TS
Austin Hospital, Melbourne, VIC. tanis.cameron@austin.org.au
McKinstry
Anita
A
Burt
Susan K
SK
Howard
Mark E
ME
Bellomo
Rinaldo
R
Brown
Douglas J
DJ
Ross
Jacqueline M
JM
Sweeney
Joanne M
JM
O'Donoghue
Fergal J
FJ
D000328:Adult; D002574:Cervical Vertebrae; D015331:Cohort Studies; D017046:Cost Savings; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D013119:Spinal Cord Injuries / Q000628:therapy*; D013904:Thoracic Vertebrae; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult