title: Improving tracheostomy care: a prospective study of the multidisciplinary approach.
abstract: OBJECTIVE
  Suboptimal 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.
  
  
  METHODS
  A 38-month prospective cohort study.
  
  
  METHODS
  A London Teaching Hospital.
  
  
  METHODS
  A total of 102 patients with tracheostomy within the 19-month pre-intervention cohort and 95 patients in the 19-month post-intervention cohort.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Time 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.
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Department of Otorhinolaryngology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. raul.cetto10@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Cetto
authors.forename: A
authors.initials: A
authors.lastname: Arora
authors.forename: R
authors.initials: R
authors.lastname: Hettige
authors.forename: M
authors.initials: M
authors.lastname: Nel
authors.forename: L
authors.initials: L
authors.lastname: Benjamin
authors.forename: C M H
authors.initials: CM
authors.lastname: Gomez
authors.forename: W L G
authors.initials: WL
authors.lastname: Oldfield
authors.forename: A A
authors.initials: AA
authors.lastname: Narula
mesh_terms: D018806:APACHE; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008131:London; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014139:Tracheostomy