Limits...
Multidisciplinary care for tracheostomy patients: a systematic review.

Garrubba M, Turner T, Grieveson C - Crit Care (2009)

Bottom Line: Risk of bias was moderate to high in all studies.All papers concluded that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU.Two papers also reported that multidisciplinary care reduced the overall length of stay in hospital as well as the length of stay following ICU discharge.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Clinical Effectiveness, Southern Health, Clayton, Victoria 3168, Australia. marie.garrubba@southernhealth.org.au

ABSTRACT

Introduction: Appropriate care for patients with tracheostomies in hospital settings is an important issue. Each year more than 7000 patients receive tracheostomies in Australia and New Zealand alone. Many of these tracheostomy patients commence their care in the intensive care unit (ICU) and once stabilised are then transferred to a general ward. Insufficient skills and experience of staff caring for tracheostomy patients may lead to sub-optimal care and increased morbidity. The purpose of this review was to identify whether multidisciplinary tracheostomy outreach teams enable the reduction in time to decannulation and length of stay in acute and sub-acute settings, improve quality of care or decrease adverse events for patients with a tracheostomy.

Methods: We included all relevant trials published in English. We searched Medline, CINAHL, All EBM and EMBASE in June 2009. Studies were selected and appraised by two reviewers in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori.

Results: Three studies were identified which met the study selection criteria. All were cohort studies with historical controls. All studies included adult patients with tracheostomies. One study was conducted in the UK and the other two in Australia. Risk of bias was moderate to high in all studies. All papers concluded that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU. Two papers also reported that multidisciplinary care reduced the overall length of stay in hospital as well as the length of stay following ICU discharge.

Conclusions: In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported.These results should be interpreted with caution due to the methodological weaknesses in the historical control studies.

Show MeSH

Related in: MedlinePlus

Number of studies included. Key reasons for exclusion: 1 = not a comparative study; 2 = irrelevant setting; 3 = irrelevant intervention; 4 = irrelevant comparator; 5 = irrelevant outcomes. Search flow chart: n = number of studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2811928&req=5

Figure 1: Number of studies included. Key reasons for exclusion: 1 = not a comparative study; 2 = irrelevant setting; 3 = irrelevant intervention; 4 = irrelevant comparator; 5 = irrelevant outcomes. Search flow chart: n = number of studies.

Mentions: The search of all databases returned 1045 articles, which were reviewed by title and abstract. When a decision could not be made based on abstract alone, full text was retrieved. A total of 59 full text articles were retrieved for review and three articles met the inclusion criteria (Figure 1).


Multidisciplinary care for tracheostomy patients: a systematic review.

Garrubba M, Turner T, Grieveson C - Crit Care (2009)

Number of studies included. Key reasons for exclusion: 1 = not a comparative study; 2 = irrelevant setting; 3 = irrelevant intervention; 4 = irrelevant comparator; 5 = irrelevant outcomes. Search flow chart: n = number of studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2811928&req=5

Figure 1: Number of studies included. Key reasons for exclusion: 1 = not a comparative study; 2 = irrelevant setting; 3 = irrelevant intervention; 4 = irrelevant comparator; 5 = irrelevant outcomes. Search flow chart: n = number of studies.
Mentions: The search of all databases returned 1045 articles, which were reviewed by title and abstract. When a decision could not be made based on abstract alone, full text was retrieved. A total of 59 full text articles were retrieved for review and three articles met the inclusion criteria (Figure 1).

Bottom Line: Risk of bias was moderate to high in all studies.All papers concluded that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU.Two papers also reported that multidisciplinary care reduced the overall length of stay in hospital as well as the length of stay following ICU discharge.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Clinical Effectiveness, Southern Health, Clayton, Victoria 3168, Australia. marie.garrubba@southernhealth.org.au

ABSTRACT

Introduction: Appropriate care for patients with tracheostomies in hospital settings is an important issue. Each year more than 7000 patients receive tracheostomies in Australia and New Zealand alone. Many of these tracheostomy patients commence their care in the intensive care unit (ICU) and once stabilised are then transferred to a general ward. Insufficient skills and experience of staff caring for tracheostomy patients may lead to sub-optimal care and increased morbidity. The purpose of this review was to identify whether multidisciplinary tracheostomy outreach teams enable the reduction in time to decannulation and length of stay in acute and sub-acute settings, improve quality of care or decrease adverse events for patients with a tracheostomy.

Methods: We included all relevant trials published in English. We searched Medline, CINAHL, All EBM and EMBASE in June 2009. Studies were selected and appraised by two reviewers in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori.

Results: Three studies were identified which met the study selection criteria. All were cohort studies with historical controls. All studies included adult patients with tracheostomies. One study was conducted in the UK and the other two in Australia. Risk of bias was moderate to high in all studies. All papers concluded that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU. Two papers also reported that multidisciplinary care reduced the overall length of stay in hospital as well as the length of stay following ICU discharge.

Conclusions: In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported.These results should be interpreted with caution due to the methodological weaknesses in the historical control studies.

Show MeSH
Related in: MedlinePlus