title: Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care.
abstract: BACKGROUND
  Multidisciplinary tracheostomy teams have been successful in improving operative outcomes; however, limited data exist on their effect on postoperative care. We aimed to determine the effectiveness of a multidisciplinary tracheostomy service alone and following implementation of a post-tracheostomy care bundle on rates of decannulation and tolerance of oral diet before discharge.
  
  
  METHODS
  Prospective data on all subjects requiring tracheostomy by any trauma/critical care surgeon were collected from January 2011 to December 2013 following development of a tracheostomy service and continued following implementation of the post-tracheostomy care bundle. Rates of decannulation and tolerance of oral diet were compared between all groups: pre-tracheostomy service (baseline, historical control), tracheostomy service alone, and tracheostomy service with post-tracheostomy care bundle.
  
  
  RESULTS
  Three hundred ninety-three subjects met the criteria for analysis with 61 in the baseline group, 124 following initiation of a tracheostomy service, and 208 after the addition of the post-tracheostomy care bundle. There were significant overall differences between all groups in the proportion of subjects decannulated, proportion of subjects tolerating oral diet, and number of subjects receiving speech evaluations. Pairwise comparisons showed no differences in decannulation or tolerance of oral diet following implementation of the tracheostomy service alone but significant improvement with the addition of the post-tracheostomy care bundle compared with baseline. (P = .002 and P = .005, respectively). Likewise, the number of speech language pathologist consults significantly increased compared with baseline only after the post-tracheostomy care bundle (P = .004). Time to speech evaluation significantly decreased with the post-tracheostomy care bundle compared with baseline and tracheostomy service (P < .013).
  
  
  CONCLUSIONS
  The addition of a post-tracheostomy care bundle to a multidisciplinary tracheostomy service significantly improved rates of decannulation and tolerance of oral diet.
authors.affiliation: Critical Care, Department of Surgery, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut. John.Mah@hhchealth.org.
authors.forename: John W
authors.initials: JW
authors.lastname: Mah
authors.affiliation: Department of Research, Hartford Hospital, Hartford, Connecticut.
authors.forename: Ilene I
authors.initials: II
authors.lastname: Staff
authors.affiliation: Speech Therapy, Department of Rehabilitation Services, Hartford Hospital, Hartford, Connecticut.
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Fisher
authors.affiliation: Critical Care, Department of Surgery, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut.
authors.forename: Karyn L
authors.initials: KL
authors.lastname: Butler
mesh_terms: D000328:Adult; D000368:Aged; D003679:Deglutition; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation; D012138:Respiratory Therapy; D012139:Respiratory Therapy Department, Hospital / Q000458:organization & administration; D013066:Speech-Language Pathology; D014139:Tracheostomy / Q000009:adverse effects*
keywords: patient care team; postoperative care; quality of life; respiratory failure; speech therapy; tracheostomy; tracheotomy