(199) Does Use of a Multidisciplinary Progression Team Improve Outcomes for Patients With Tracheostomies?

Introduction: Critically ill patients require tracheostomies for a variety of reasons. Once the acute need for tracheostomy placement has resolved, the goal becomes progression towards decannulation. The aim of the study was to evaluate whether implementation of an interdisciplinary progression team led to improved outcomes in hospitalized patients with tracheostomies.

Methods: After IRB approval, a pre- and post- implementation study was conducted in a tertiary urban academic hospital. Records of tracheostomized adult (≥18 years old) patients were included; An interdisciplinary team, including critical care physicians, RTs, and SLPs, was created with the intent to design and implement a protocol for tracheostomy progression. The protocol included weekly interdisciplinary tracheostomy progression rounds to systematically review all patients admitted to the hospital.
Data from the year prior to the tracheostomy progression team creation (December 2020 to December 2021) was utilized as the pre-intervention cohort and compared to data following the creation of the progression team (January 2022 to January 2023).

Results: 84 patients met inclusion criteria during the pre-implementation period while 99 patients were included in the post-implementation cohort. There was a significant increase in the percentage of patients being discharged home (9% to 16%, p=0.038), tracheostomies downsized during hospitalization (52% vs 75%, p=0.001), capping rates (24% vs 44%, p=0.003) and decannulation rates (20% vs 40%, p=0.004). There was a decrease of approximately five days in hospital LOS though this was not statistically significant (p=0.351) as the study was underpowered to appreciate a difference.

Conclusions: The creation of an interdisciplinary tracheostomy team results in improved tracheostomy downsize and decannulation rates, as well as more patients being discharged home. With larger patient samples, the initiation of a standardized decannulation protocol may ultimately reduce hospital length of stay.