Driving standards in tracheostomy care: a preliminary communication of the St Mary's ENT-led multi disciplinary team approach

Objectives: To assess tracheostomy care and improve standards following the introduction of an ENT-led multidisciplinary tracheostomy ward round service. Design: Prospective third cycle audit. Setting: Tertiary academic London hospital serving an inner city population of multi-ethnic background (St Mary's Hospital, Paddington, London). Participants: Patients with a tracheostomy discharged from ITU to general wards. Implemented actions: Establishment of an ENT-led Tracheostomy Multidisciplinary Team (TMDT). Weekly TMDT ward round to manage patients with a tracheostomy. ENT-led educational and training sessions for allied healthcare professionals. Main outcome measures: Compliance with local tracheostomy care guidelines (St Mary's tracheostomy care bundle) and time to tracheostomy tube decannulation. Results: Preliminary results of 10 patients show improved compliance with tracheostomy care guidelines, established in 2004, rising to 94%. Average time to decannulation was significantly reduced from 21 to 5 days (P-value = 0.0005, Mann Whitney Wilcoxon Test). The mean total tracheostomy time was reduced from 34 to 24 days although this was not statistically significant (P-value = 0.13, Mann Whitney Wilcoxon Test). Conclusions: The introduction of regular ENT-led multidisciplinary input for patients with a tracheostomy significantly improved compliance with nursing care standards. There was also a reduction in the total length of time tracheostomy tubes remain in situ, with time to decannulation significantly reduced.