Impact of Multidisciplinary Tracheostomy Team Implementation on Adult Patient Outcomes

Background: Tracheostomies serve various medical purposes, often requiring timely removal once patients can sustain their airways independently. Due to the medical complexity of tracheostomy patients, they create a high level of burden to the healthcare system. Collaboration among healthcare disciplines can expedite this process, benefiting both patients and institutions. We aim to assess the impact of a multidisciplinary tracheostomy team in our 766-bed Adult Level-1 Trauma academic medical center. Methods: An IRB exempt retrospective review evaluated length of stay (LOS), decannulation rate, time to decannulation, and patient discharge disposition between March 2023 and May 2024. An initial implementation phase commenced June of 2023 with speech therapy and respiratory therapy support alone. Subsequently, in February 2024, the multidisciplinary team with the addition of clinical nurse specialists and case management was introduced. Weekly meetings were held to discuss patient progress and formulate care recommendations. Excluded were tracheostomies by the otolaryngology team and LOS data for deceased inpatients. Results: Following implementation of the secondary team intervention, overall hospital LOS decreased intervention for all tracheostomized patients from 29 and 31 d to 24.5 d. Patients successfully decannulated experienced a substantial decrease in LOS after secondary intervention (32 and 34.5 to 24 d). The time to decannulation was decreased with the primary team intervention between speech and respiratory (17 to 13.5 and 12 d). In patients discharged with a tracheostomy there was an initial decrease in LOS. However, with the introduction of the subsequent intervention, there was a regression to baseline (29 vs 22 vs 28 d). Decannulation rate and discharge disposition remained consistent pre- and post-implementation. Conclusions: Our findings suggest that a multidisciplinary approach improves patient outcomes, particularly in reducing LOS and time to decannulation. Enhanced communication and collaborative decision-making play pivotal roles in achieving improved outcomes. There are opportunities to further improve care and outcomes of tracheostomized patients. Clear tracheostomy progression pathways and communication with bedside staff will continue to increase the number of patients able to decannulate.Tracheostomized Patient Outcomes: Pre-Intervention, Primary Intervention, and Secondary Intervention Comparison Pre-Intervention(March 2023-May 2023)Primary Intervention(July 2023-September 2023)Secondary Intervention(February 2024-April 2024)Total tracheostomized patients (n)343636Patients decannulated (n, %)12, 35.29%14, 38.89%13, 36.11%Overall patient LOS (days)293124.5Discharged with trach LOS (days)292228Decannulated patient LOS (days)3234.524Time with Tracheostomy (days)1713.512Patient Discharge DispositionsDisposition   Long Term Acute Care Hospital171515Inpatient Rehabilitation Facility988Home456Sub-Acute Rehabilitation111Skilled Nursing Facility210Outside Hospital015Hospice100Deceased055