A Real-World Study on the Role of a Multidisciplinary Tracheostomy Team in Critically Ill Patients – Uptake and Impact of Timing on Outcomes

Background: Patients with a tracheostomy tube (TT) may receive varying standards of care post discharge from intensive care unit (ICU) in the absence of a specialized tracheostomy care team. The effect of a tracheostomy team on patients and safety outcomes remains equivocal in studies with physician-led multidisciplinary model that provided twice weekly reviews. A tracheostomy review service (TRS) was formed in our hospital in 2017. We aimed to evaluate the real-world impact of a TRS in terms of service uptake and timing of referral, and their effect on patient outcomes. Methods: This retrospective study included all patients discharged from Medical and Surgical ICUs with TT in-situ between January 2017 and December 2018. Data excluded patients under otolaryngology service, long term TT, discharged to other acute institutions, or deemed to require long-term mechanical ventilation for analysis. This study was approved by SingHealth Centralised Institutional Review Board (Ref: 2017/2313). Results: One hundred and fifty-six post ICU patients had TT in-situ in the 2-year study, out of which 63(40.4%) patients were referred to the TRS. A total of 52 subjects were included for analysis; 20 of which were referred to the TRS within 7 days (early group), and 32 after 7 days (late group). There were no significant differences in median age (65.0 vs. 63.5; P = .748), median Acute Physiology and Chronic Health Evaluation (APACHE) II Score (22.5 vs. 20.5; P = .37), and median timing of tracheostomy creation (12.5 vs.14.5; P = .66). A total of 32 patients were decannulated at hospital discharge. The early group had a higher proportion of decannulation success at discharge than the late group (80.0 vs. 50.0%; P = .04). In addition, the early group also tolerated cuff deflation trial sooner [7 (4-9) vs. 17 (9-22) days; P = .001] than the late group. The first tube change post-tracheostomy also took place earlier in the former group [10 (7-11) vs. 19 (11-32) days; P = .001] compared to the latter. Conclusions: Early referral to TRS within 7 days is associated with earlier cuff deflation, and tube change, and a higher rate of decannulation upon discharge. With these findings, we aim to implement early TRS review hospital-wide such that all TT patients post ICU discharge will benefit from this multidisciplinary service.