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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.
ORCID: 0000-0002-2562-1829
Journal: Critical Care and Resuscitation
Type: Journal Article
Subjects: Adult
Cervical Vertebrae
Cohort Studies
Cost Savings
Intensive Care.organization & administration
Intubation, Intratracheal
Length of Stay
Middle Aged
Patient Care Team.organization & administration
Program Evaluation
Spinal Cord Injuries.therapy
Thoracic Vertebrae
Treatment Outcome
Young Adult
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