Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/10786
Title: Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team.
Austin Authors: Cameron, Tanis S ;McKinstry, Anita;Burt, Susan K;Howard, Mark E ;Bellomo, Rinaldo ;Brown, Douglas J;Ross, Jacqueline M ;Sweeney, Joanne M ;O'Donoghue, Fergal J 
Affiliation: Austin Hospital, Melbourne, VIC.
Issue Date: 1-Mar-2009
Publication information: Critical Care and Resuscitation; 11(1): 14-9
Abstract: 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.Matched-pairs design with two cohorts, before and after the intervention.900-bed tertiary hospital in Melbourne, Victoria.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).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.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.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.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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/10786
ORCID: 0000-0002-2562-1829
URL: https://pubmed.ncbi.nlm.nih.gov/19281439
Type: Journal Article
Subjects: Adult
Cervical Vertebrae
Cohort Studies
Cost Savings
Female
Humans
Intensive Care.organization & administration
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
Appears in Collections:Journal articles

Show full item record

Page view(s)

12
checked on Dec 7, 2022

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.