Tracheostomy Management in the Outpatient Care Setting

Abstract

Background:

There is increasing evidence that coordinated interdisciplinary tracheostomy care can influence the safety and quality of care for patients. Given the growing complexity of patients and tracheal airways, our institution was experiencing an increase in the number of respiratory care calls to the outpatient cancer infusion center. We also recognize that outpatient clinics and centers may be particularly vulnerable to significant delay in response to what could be a tracheostomy emergency and potential root cause analysis. A delay in this setting might be multifactorial to include the physical distance between Respiratory Care Service and the outpatient clinic and competing in-hospital emergencies.

Methods:

In efforts to decrease delay in timely tracheostomy assessment and management, Respiratory Care Service established a comprehensive nursing education pathway aimed at increasing nurses’ skill and comfort level when managing tracheostomized patients in our outpatient cancer infusion center. The education pathway included basic tracheostomy assessment and care, and associated supplies. Also included in as part of this pathway was weekly outcomes communication between Respiratory Care Service and the infusion center.

Results:

In fiscal year 2022 there was a stable volume of 178 visits to the cancer infusion center by patients with tracheostomies. The average number of respiratory care service calls/visits to the infusion clinic prior to our intervention was 2-4 times a day, for 5 days a week. After implementation of our tracheostomy education pathway this dropped to 1-2 times week.

Conclusions:

Implementing a collaborative education pathway in our outpatient cancer infusion center Respiratory Care Service was able to decrease unnecessary service calls by 84%. This interdisciplinary partnership has led to streamlined and timely tracheostomy care, increased patient satisfaction, and safer practices when managing tracheostomized patient. Particularly in a time of SARS-CoV-2.