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Title: Tracheostomy clinical practices and patient outcomes in three tertiary metropolitan hospitals in Australia.
Austin Authors: Zaga, Charissa J ;Berney, Sue ;Hepworth, Graham;Cameron, Tanis S ;Baker, Sonia;Giddings, Charles;Howard, Mark E ;Bellomo, Rinaldo ;Vogel, Adam P
Affiliation: Speech Pathology
Institute for Breathing and Sleep
Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia.
Tracheostomy Review and Management Service
Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia.
Respiratory and Sleep Medicine
Intensive Care
Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia
Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Department of Critical Care, University of Melbourne, Melbourne, Australia
Department of Neurodegeneration, Hertie Institute for Clinical Brian Research, Tübingen, Germany
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
Redenlab, Mebourne, Australia.
Issue Date: May-2023
Date: 2022
Publication information: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses 2023; 36(3)
Abstract: There is a paucity of literature in Australia on patient-focused tracheostomy outcomes and process outcomes. Exploration of processes of care enables teams to identify and address existing barriers that may prevent earlier therapeutic interventions that could improve patient outcomes following critical care survival. The objectives of this study were to examine and provide baseline data and associations between tracheostomy clinical practices and patient outcomes across three large metropolitan hospitals. We performed a retrospective multisite observational study in three tertiary metropolitan Australian health services who are members of the Global Tracheostomy Collaborative. Deidentified data were entered into the Global Tracheostomy Collaborative database from Jan 2016 to Dec 2019. Descriptive statistics were used for the reported outcomes of length of stay, mortality, tracheostomy-related adverse events and complications, tracheostomy insertion, airway, mechanical ventilation, communication, swallowing, nutrition, length of cannulation, and decannulation. Pearson's correlation coefficient and one-way analyses of variance were performed to examine associations between variables. The total cohort was 380 patients. The in-hospital mortality of the study cohort was 13%. Overall median hospital length of stay was 46 days (interquartile range: 31-74). Length of cannulation was shorter in patients who did not experience any tracheostomy-related adverse events (p= 0.036) and who utilised nonverbal communication methods (p = 0.041). Few patients (8%) utilised verbal communication methods while mechanically ventilated, compared with 80% who utilised a one-way speaking valve while off the ventilator. Oral intake was commenced in 20% of patients prior to decannulation. Patient nutritional intake varied prior to and at the time of decannulation. Decannulation occurred in 83% of patients. This study provides baseline data for tracheostomy outcomes across three large metropolitan Australian hospitals. Most outcomes were comparable with previous international and local studies. Future research is warranted to explore the impact of earlier nonverbal communication and interventions targeting the reduction in tracheostomy-related adverse events.
DOI: 10.1016/j.aucc.2022.03.002
Journal: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
Start page: 327
End page: 335
PubMed URL: 35490111
Type: Journal Article
Subjects: Adverse events
Appears in Collections:Journal articles

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