title: Can an interprofessional tracheostomy team improve weaning to decannulation times? A quality improvement evaluation.
abstract: BACKGROUND
  Percutaneous tracheostomy is a common procedure in the intensive care unit and, on patient transfer to the wards, there is a gap in ongoing tracheostomy management. There is some evidence that tracheostomy teams can shorten weaning to decannulation times. In response to lengthy weaning to decannulation times at Trillium Health Partners - Credit Valley Hospital site (Mississauga, Ontario), an interprofessional tracheostomy team, led by respiratory therapists and consisting of speech-language pathologists and intensive care physicians, was implemented.
  
  
  OBJECTIVE
  To evaluate the interprofessional tracheostomy team and its impact on time from weaning off mechanical ventilation to decannulation; and time from weaning to speech-language pathology referral.
  
  
  METHODS
  Performance metrics were collected retrospectively through chart review pre- and post-team implementation. The primary metrics evaluated were the time from weaning off mechanical ventilation to decannulation, and time to referral to speech-language pathology.
  
  
  RESULTS
  Following implementation of the interprofessional tracheostomy team, there was no improvement in decannulation times or time from weaning to speech-language pathology referral. A significant improvement was noted in the average time to first tracheostomy tube change (36.2 days to 22.9 days; P=0.01) and average time to speech-language pathology referral following initial tracheostomy insertion (51.8 days to 26.3 days; P=0.01).
  
  
  CONCLUSIONS
  An interprofessional tracheostomy team can improve the quality of tracheostomy care through earlier tracheostomy tube changes and swallowing assessment referrals. The lack of improved weaning to decannulation time was potentially due to poor adherence with established protocols as well as a change in mechanical ventilation practices. To validate the findings from this particular institution, a more rigorous quality improvement methodology should be considered in addition to strategies to improve protocol compliance.
authors.affiliation: Quality Department, Trillium Health Partners, Mississauga, Ontario.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Welton
authors.affiliation: Quality Department, Trillium Health Partners, Mississauga, Ontario.
authors.forename: Melissa
authors.initials: M
authors.lastname: Morrison
authors.affiliation: Quality Department, Trillium Health Partners, Mississauga, Ontario.
authors.forename: Marifel
authors.initials: M
authors.lastname: Catalig
authors.affiliation: Quality Department, Trillium Health Partners, Mississauga, Ontario.
authors.forename: Juliana
authors.initials: J
authors.lastname: Chris
authors.affiliation: Quality Department, Trillium Health Partners, Mississauga, Ontario.
authors.forename: Janos
authors.initials: J
authors.lastname: Pataki
keywords: Decannulation; Intensive care; Interprofessional; Quality improvement; Respiratory therapy; Tracheostomy