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Outreach-led tracheostomy service in a cardiothoracic centre: early and safe facilitated discharge from critical care

Introduction

A retrospective analysis of a year cohort of tracheostomies discharged from intensive care in a specialist cardiothoracic centre was undertaken to analyse whether facilitated outreach-led discharge was safe.

Methods

A retrospective analysis of the ICU database was undertaken to identify all patients who had a tracheostomy (percutaneous or surgical) inserted in the ICU, and a chart review of patients discharged from the ICU with a tracheostomy in situ was performed. The following variables were collected: patient demographics; diagnosis; number of days of tracheostomy in situ; number of days on noninvasive ventilation (CPAP); and tracheostomy-related complications. A review of the risk management database was performed to identify any tracheostomy-related reported adverse events.

Results

One hundred and eight tracheostomies were performed in intensive care in the 2-year period. Sixty-two patients were discharged with tracheostomy in situ and were reviewed by the outreach team for a cumulative total of 710 days until decannulation. There were 383 days whereby patients with a tracheostomy in situ had been noninvasively ventilated. There were three reported critical events relating to tracheostomy and no deaths.

Conclusion

More than 60% of patients who had a tracheostomy inserted are discharged from critical care with a tracheostomy in situ. With the support of the outreach team these patients were successfully managed in Level 2 and Level 1 areas. This reduced the requirement for critical care (Level 3) bed-days. There was a low rate of complications. We concluded that outreach services can facilitate early and safe discharge of tracheostomy patients from critical care.

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Wilton, P., Mitchell, J., Apps, T. et al. Outreach-led tracheostomy service in a cardiothoracic centre: early and safe facilitated discharge from critical care. Crit Care 11, P217 (2007). https://doi.org/10.1186/cc5377

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Keywords

  • Public Health
  • Adverse Event
  • Emergency Medicine
  • Retrospective Analysis
  • Risk Management