Safety and Feasibility of Bedside Percutaneous Dilatational Tracheostomy Team in a Community Hospital

Background: Percutaneous dilatational tracheostomy (PDT) is a widely used procedure in intensive care units (ICUs) for patients requiring prolonged airway support. Traditionally, PDT is performed by two physicians—an intensivist or surgeon, and a second physician providing bronchoscopy guidance. However, many community hospitals face a shortage of intensivists and limited resources, prompting the need to evaluate the safety and feasibility of a bedside PDT team model that utilizes available hospital staff in such settings. Aim and Objectives: This study aims to demonstrate that PDTs can be safely performed in a community hospital with limited resources by a team led by an intensivist and supported by a hospitalist or internal medicine resident. The objective is to assess procedural safety, team composition, and resource utilization, encouraging similar institutions to establish PDT teams without the need for multiple subspecialists. The study does not address optimal timing of tracheostomy or compare PDT with surgical tracheostomy. Methods: We conducted a single-center retrospective case series analyzing all PDTs performed between 2017 and June 2020 in a community hospital. The study included 42 patients who underwent 43 PDT procedures. The bedside PDT team consisted of an intensivist, a hospitalist or internal medicine resident, a respiratory therapist, and a nurse. A standardized 15-point procedural safety checklist was used, and patient selection was guided by clinical examination and neck ultrasound to identify contraindications. All team members received targeted training in airway management and crew resource management (CRM) tactics to enhance safety and communication. Results: Out of 43 PDTs performed, no procedural deaths occurred, and major complications were infrequent. Seven deaths within seven days post-procedure were unrelated to PDT. The mean patient age was 65.6 years, and 31% had a BMI ≥30 kg/m2. The average procedure time was 18 minutes. Complications included two cases of accidental decannulation, one significant hemorrhage requiring surgical intervention, and one case of cellulitis, all of which were managed appropriately. No cases resulted in permanent loss of airway, paratracheal cannulation, tracheal perforation, or pneumothorax. Team protocols and staff education were adapted following adverse events, such as mandatory suture placement for tube security and enhanced anticoagulation management. Conclusion: The establishment of a bedside PDT team in a community hospital is both safe and feasible, even with limited resources and staffing. Effective training, standardized protocols, and CRM strategies contribute to procedural safety and positive patient outcomes. These findings support the adoption of similar PDT teams in resource-limited settings, potentially improving access to tracheostomy care without reliance on multiple subspecialists. Limitations: It is important to note that the findings from this study should not be generalized to all community hospitals, especially those that do not have PDT team members with sufficient or appropriate training. The safety and feasibility outcomes observed in this case series are directly tied to the presence of a multidisciplinary team whose members had received targeted education in airway management, neck ultrasound, and crew resource management tactics. Therefore, hospitals lacking similarly trained staff may not achieve comparable results, and the implementation of bedside PDT should be approached with caution in such settings.