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Dan Med J. 2012 Aug;59(8):A4481.

Inadequate follow-up after tracheostomy and intensive care.

Author information

1
Anæstesiologisk Afdeling, Næstved Sygehus, 4700 Næstved, Denmark. frederik.mondrup@gmail.com

Abstract

INTRODUCTION:

When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the ward.

MATERIAL AND METHODS:

We performed an electronic questionnaire survey among heads of unit at registered Danish ICUs.

RESULTS:

A total of 34 out of 43 ICUs responded. 56% of the ICUs do not document individual plans for decannulation in the patient's chart. 91% of the ICUs do not perform daily follow-up of tracheotomised patients on the ward. No guidelines for decannulation on the ward were found, and only 6% have a guideline for accidental decannulation. Furthermore, as little as 47% of the ICUs report any formalized education or training of staff nurses in the management of tracheotomised patients.

CONCLUSION:

Guidelines relevant to patients discharged from Danish ICUs with a tracheal cannula in situ are scarce; few ICUs employ individualized plans for tracheostomy management and decannulation; there is largely no daily intensivist-led post-ICU follow-up, and formal staff education in tracheostomy management on the ward is scarce. Altogether these factors create a potential for adverse events and increased morbidity in this high-risk, high-cost patient population. Possibly individualized plans for tracheotomised patients as well as intensivist-led follow-up on the ward can improve patient outcome and safety and this should be confirmed in a future study.

FUNDING:

not relevant.

TRIAL REGISTRATION:

not relevant.

PMID:
22849980
[Indexed for MEDLINE]
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