Driving standards in tracheostomy care: a preliminary communication of the St Mary's ENT-led multi disciplinary team approach

Clin Otolaryngol. 2008 Dec;33(6):596-9. doi: 10.1111/j.1749-4486.2008.01814.x.


Objectives: To assess tracheostomy care and improve standards following the introduction of an ENT-led multidisciplinary tracheostomy ward round service.

Design: Prospective third cycle audit.

Setting: Tertiary academic London hospital serving an inner city population of multi-ethnic background (St Mary's Hospital, Paddington, London).

Participants: Patients with a tracheostomy discharged from ITU to general wards. IMPLEMENTED ACTIONS: Establishment of an ENT-led Tracheostomy Multidisciplinary Team (TMDT). Weekly TMDT ward round to manage patients with a tracheostomy. ENT-led educational and training sessions for allied healthcare professionals.

Main outcome measures: Compliance with local tracheostomy care guidelines (St Mary's tracheostomy care bundle) and time to tracheostomy tube decannulation.

Results: Preliminary results of 10 patients show improved compliance with tracheostomy care guidelines, established in 2004, rising to 94%. Average time to decannulation was significantly reduced from 21 to 5 days (P-value = 0.0005, Mann Whitney Wilcoxon Test). The mean total tracheostomy time was reduced from 34 to 24 days although this was not statistically significant (P-value = 0.13, Mann Whitney Wilcoxon Test).

Conclusions: The introduction of regular ENT-led multidisciplinary input for patients with a tracheostomy significantly improved compliance with nursing care standards. There was also a reduction in the total length of time tracheostomy tubes remain in situ, with time to decannulation significantly reduced.

MeSH terms

  • Adult
  • Aged
  • Guideline Adherence*
  • Hospitals, Urban / standards
  • Humans
  • London
  • Medical Audit
  • Middle Aged
  • Nursing Care / standards
  • Patient Care / standards*
  • Patient Care Team / standards*
  • Retrospective Studies
  • Tracheostomy* / standards