부산대학교 도서관

BACKGROUND: Routine tracheostomy care has traditionally been a shared responsibility between respiratory therapy, and nursing. Our large tertiary teaching medical center has a team of respiratory therapists whose primary responsibility is to round on tracheostomized patients admitted to the general floors, and to ensure the most appropriate and timely patient care. Trach care in our ICU has historically been provided by critical care nurses with no formal guidelines. In 2014 the respiratory department implemented new guidelines that shifted tracheostomy care responsibility from the ICU nurses to respiratory therapists. These guidelines included bedside trach care and formal communications with the multidisciplinary team regarding suture removal, trach down-sizing and other issues pertaining to transition to the general floors. Our group wanted to investigate whether these changes impacted outcomes. METHOD: After obtaining approval from our institutional review board, our team evaluated 112 tracheostomized patients. Data points collected included ICU days, hospital days, days till formal rehab, ventilator days, days till suture removal, days till first speaking valve trial, days till speech therapy consult, days till first tracheostomy mask trial and days till first ambulation. RESULTS: There were 56 patients in the pre-implementation group and 56 in the post. Median ICU days were 18.5 and 16.0 (-2.5) (p=0.18), hospital days 27 and 24.5 (-2.5) (p=0.06), Rehab days 19.0 and 17.0 (-2.0) (p=0.12), ventilator days 15.0 and 15.0 (no difference) (p=0.69), days till de- cannulation 17.0 and 22.0 (+5.0) (p=0.07), days till suture removal 7.0 and 6.0 (-1.0) (p = 0.91, days till first speaking valve trial 10.0 and 10.00 (no difference) (p=0.93), days till tracheostomy down-size 10.5 and 10.0 (-0.5) (p= 1.0), days till speech therapy consult 6.0 and 5.5 (-0.5) (p=0.58), days till first tracheostomy mask trial 2.0 and 3.5 (+1.5) (p=0.39) and days till first ambulation 18.0 and 14.5 (-3.5) (p=0.11). All groups were evaluated using Analyse-it statistical analysis software (UK) and two tailed t-test's. CONCLUSIONS: several parameters demonstrated positive changes that reached clinical significance but not statistical significance, (p < .05, 95% Cl). These included ICU days, hospital days, days till suture removal, rehab days, days till down-size, days till speech consult, and days till first ambulation. Further study will be needed to prove statistical significance.