Multidisciplinary Tracheotomy Teams: An Analysis of Patient Outcomes and Resource Allocation
| Autor: | Anders Sideris, Nancy Briggs, Timothy R. Holmes, Benjamin Cumming, Jennifer W Lee, Thomas Havas |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care medicine.medical_treatment Psychological intervention law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine Tracheotomy Randomized controlled trial Cost Savings Multidisciplinary approach law medicine Humans 030212 general & internal medicine Hospital Costs 030223 otorhinolaryngology Adverse effect Intensive care medicine Aged Patient Care Team business.industry Length of Stay Middle Aged Intensive care unit Patient Outcome Assessment Otorhinolaryngology Head and neck surgery Resource allocation Female business |
| Zdroj: | Ear, Nose & Throat Journal. 98:232-237 |
| ISSN: | 1942-7522 0145-5613 |
| DOI: | 10.1177/0145561319840103 |
| Popis: | We sought to establish the effect of introducing a multidisciplinary tracheotomy management team (MDT). Tracheotomies are high-cost interventions with potentially devastating complications. Multidisciplinary teams have been introduced in many hospitals with the aim of reducing complications, however, data supporting them are lacking. There is currently insufficient evidence to conclude MDTs reduce length of hospital or intensive care unit (ICU) stay, and there is little information on cost analysis. A chart review identified patients who had a tracheotomy inserted at a major metropolitan teaching hospital with an acute spinal medicine service 2 years before and after the MDT was implemented. The primary outcome was time to decannulation. Other outcomes included tracheotomy complications, the proportion of patients decannulated, length of ICU and hospital stay, and admission cost. Our search identified 174 (78 prior and 96 post-MDT) patients. Baseline demographics were similar between groups. There was no difference in time to decannulation, the decannulation rate, or the length of hospital or ICU stay. Complication rates were low in both groups. There was an increase in the proportion of patients who received speaking valves and a reduction in cost of admission in a subgroup of patients who did not undergo head and neck surgery. There is insufficient evidence to support the widespread introduction of tracheotomy MDTs. Institutions considering introducing a tracheotomy team should carefully consider their case-mix, volume, and available resources as well as the structure and responsibilities of the team, and the timing of its activities within the working week. The potential benefits of MDTs including teaching of staff, and collaboration of teams should be acknowledged. Given the potentially significant implications for cost to the health system, a randomized trial is needed to guide policy in this area. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|