Creating Institutional Awareness and Standardizing Care of Adult Patients With Neck Airways

Abstract

Background:

In a 500 bed academic medical center comprised of multiple medical specialties that provide tracheostomy and laryngectomy services to the adult patient population. It was observed that there was a limited standard and quality of care. A team was created to develop standards and improve the quality of care for this patient population, their families and staff to ensure the highest standards in patient safety and experience.

Methods:

In November 2017 a Multidisciplinary Neck Airway Team consisting of a Team Coordinator (respiratory therapist), attending physician, speech pathologist and a wound care nurse was created to round weekly on all adult neck airway patients. The Multidisciplinary Neck Airway Team rounds include assessment of the airway device, skin integrity, emergency supplies, weaning needs such as (initial or routine trach changes, downsizing, speaking valves, swallow studies, capping trials and decannulation). The Multidisciplinary Neck Airway team coordinator is available throughout the week to provide help and resources for questions, concerns, order placement needs and supplies and evaluates patients that have been intubated with an endotracheal tube greater than 96 hours for possible early tracheostomy in collaboration with the patient’s provider. Working closely with social services, care coordination, clinical staff and the adult rehabilitation team, the Multidisciplinary team aids in the implementation of education for patients and family members to encourage independence and knowledge for discharge.

Results:

Based on our data provided to Vizient, baseline average length of stay (LOS) for this patient population for one year was 26 days; average direct cost of care was $76,000 per patient encounter. Post official launch of the team in April 2018, we analyzed the first 30 patients seen as part of the program. The LOS dropped to 25 days and the direct cost of care decreased to $64,000 per encounter. While these improvements are not statistically significant, the data set is small and are considered preliminary findings in this body of work, the team feels confident in the worthiness of this program.

Conclusions:

The implementation of this Multidisciplinary Neck Airway Team created institutional awareness and standardization, improving patient safety and quality. This in turn may decrease LOS, cost, related pressure injuries, length of mechanical ventilation, and possibly readmissions.