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National survey of ICUs in the UK: discharging patients with tracheostomies

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Introduction

Respiratory weaning in ICUs can be a lengthy and expensive process [1], but may be facilitated by the use of tracheostomies. Discharging patients with tracheostomies to general wards improves ICU bed availability but raises potential patient safety issues. This is demonstrated by the increased mortality compared with patients decannulated before discharge from the ICU [2]. We investigated how often ICUs in the UK discharge patients with tracheostomies to wards, which wards these are and whether systems are in place to ensure adequate safety on discharge.

Methods

We telephoned 217 ICUs in the UK. Nursing staff answered a series of questions regarding the discharge of patients with tracheostomies to the wards and their follow-up.

Results

We obtained information from 203 ICUs. A total of 201 units used tracheostomies for respiratory weaning. In total, 151 routinely discharged patients to wards with tracheostomies, 11 never did and 39 did occasionally. Five discharged to the high dependency unit only, 60 to respiratory wards only, 70 to specialist wards and 15 to any or most wards. Eighty-five out of 190 units discharged patients with tracheostomy cuffs both up and down, 72 discharged with the cuff down or cuffless and 16 with the cuff'usually down'. A total of 141 hospitals had routine follow-up for tracheostomy patients from critical care outreach or other services. Critical care outreach was available 24 hours a day in 65 hospitals.

Conclusion

The vast majority of ICUs in the UK perform tracheostomies for respiratory weaning and many routinely discharge patients to the wards prior to decannulation. Routine follow-up is usually available, but cover may only be available during the day. Patients may go to a specialist ward with trained nurses but this is not always the case. Patients are often discharged to wards with their tracheostomy cuff up, raising major safety issues if their tracheostomy tubes block and nurses are not trained for such emergencies. Twenty-four hours a day critical care outreach cover may improve patient safety, but further research and the production of guidelines is needed to facilitate the safe discharge of patients with tracheostomies from ICU to the wards.

References

  1. 1.

    Vitacca M, et al.: [Experience of an intermediate respiratory intensive therapy in the treatment of prolonged weaning from mechanical ventilation] [Review in Italian]. Anestesiology 1996, 62: 57-64.

  2. 2.

    Martinez GH, et al.: Tracheostomy tube in place at intensive care unit discharge is associated with increased ward mortality. Respir Care 2009, 54: 1644-1652.

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Author information

Correspondence to A Garrett.

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Cite this article

Garrett, A., Strauss, C. & Saha, S. National survey of ICUs in the UK: discharging patients with tracheostomies. Crit Care 18, P325 (2014). https://doi.org/10.1186/cc13515

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Keywords

  • Patient Safety
  • General Ward
  • Tracheostomy Tube
  • Improve Patient Safety
  • High Dependency Unit