A multidisciplinary approach to post intensive care tracheostomy weaning and the impact of a dedicated team on decannulation rates and outcome in a regional UK major trauma centre

Background: Percutaneous tracheosotmies are commonly performed in intensive care to expedite weaning from mechanical ventilation especially following major trauma, acquired brain injury or severe respiratory failure. Often patients are discharged from the intensive care unit (ICU) to a ward environment with no specialist follow up Aim: To evaluate the effectiveness of a multi-disciplinary tracheostomy team (MDT) at reducing the total length of hospital stay and improving decannulation rates in tracheostomy patients once discharged from ICU Method: The team consisted of a Consultant, Physiotherapist, Speech and Language Therapist, a Head & Neck Specialist Nurse and a Critical Care Outreach Nurse. The team met weekly on the neurosurgery and respiratory wards and may prescribe treatments or therapies, offer advice to ward staff or carry out interventions. Audit data was gathered for 6 months preceding the establishment of the team and during the 6 month pilot period. Result: Based on around 62 patients being discharged to neurosurgical and respiratory wards per year, the permanent introduction of a Trust Tracheostomy MDT has the potential to reduce the time patients spend with a temporary tracheostomy in situ by 50% and in patient bed use by 911 days per year. Conclusion: A Tracheostomy MDT is an essential service to ensure timely decannulation as well as reducing hospital length of stay and improving overall outcome.