Outcomes of Patients With Spinal Cord Injury Before and After Introduction of an Interdisciplinary Tracheostomy Team

Crit Care Resusc. 2009 Mar;11(1):14-9.

Abstract

Objectives: 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.

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

Setting: 900-bed tertiary hospital in Melbourne, Victoria.

Participants: 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).

Intervention: 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.

Main outcome measures: 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.

Conclusion: 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.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Cervical Vertebrae
  • Cohort Studies
  • Cost Savings
  • Critical Care / organization & administration*
  • Female
  • Humans
  • Intubation, Intratracheal*
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration*
  • Program Evaluation
  • Spinal Cord Injuries / therapy*
  • Thoracic Vertebrae
  • Tracheostomy*
  • Treatment Outcome
  • Young Adult