Inadequate follow-up after tracheostomy and intensive care

Dan Med J. 2012 Aug;59(8):A4481.


Introduction: When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the ward.

Material and methods: We performed an electronic questionnaire survey among heads of unit at registered Danish ICUs.

Results: A total of 34 out of 43 ICUs responded. 56% of the ICUs do not document individual plans for decannulation in the patient's chart. 91% of the ICUs do not perform daily follow-up of tracheotomised patients on the ward. No guidelines for decannulation on the ward were found, and only 6% have a guideline for accidental decannulation. Furthermore, as little as 47% of the ICUs report any formalized education or training of staff nurses in the management of tracheotomised patients.

Conclusion: Guidelines relevant to patients discharged from Danish ICUs with a tracheal cannula in situ are scarce; few ICUs employ individualized plans for tracheostomy management and decannulation; there is largely no daily intensivist-led post-ICU follow-up, and formal staff education in tracheostomy management on the ward is scarce. Altogether these factors create a potential for adverse events and increased morbidity in this high-risk, high-cost patient population. Possibly individualized plans for tracheotomised patients as well as intensivist-led follow-up on the ward can improve patient outcome and safety and this should be confirmed in a future study.

Funding: not relevant.

Trial registration: not relevant.

MeSH terms

  • Clinical Competence
  • Continuity of Patient Care / organization & administration
  • Continuity of Patient Care / standards*
  • Cross-Sectional Studies
  • Denmark
  • Device Removal / standards*
  • Hospitalization
  • Humans
  • Intensive Care Units / standards*
  • Patient Care Planning / standards
  • Patient Safety
  • Patient Transfer
  • Practice Guidelines as Topic
  • Process Assessment, Health Care*
  • Surveys and Questionnaires
  • Tracheostomy / adverse effects
  • Tracheostomy / education
  • Tracheostomy / standards*