Tracheostomy management in Acute Care Facilities - a matter of teamwork
Aim. Implement and evaluate an inter‐disciplinary team approach to tracheostomy management in non‐critical care. Background. Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU...
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| Veröffentlicht in: | Journal of clinical nursing 2010-05, Vol.19 (9-10), p.1275-1283 |
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| container_title | Journal of clinical nursing |
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| creator | Parker, Vicki Giles, Michelle Shylan, Gai Austin, Nicole Smith, Kelvin Morison, Jane Archer, Wendy |
| description | Aim. Implement and evaluate an inter‐disciplinary team approach to tracheostomy management in non‐critical care.
Background. Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient’s destination after ICU.
Design. A mixed method evaluation incorporating quantitative and qualitative approaches.
Method. Data collection included pre‐implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis.
Results. Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50–27 days (p |
| doi_str_mv | 10.1111/j.1365-2702.2009.03155.x |
| format | Article |
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Background. Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient’s destination after ICU.
Design. A mixed method evaluation incorporating quantitative and qualitative approaches.
Method. Data collection included pre‐implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis.
Results. Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50–27 days (p < 0·0001) and an increase in the number of tracheostomy patients transferred to non‐critical care wards in the postgroup (p = 0·006). The number of wards accepting patients from ICU increased from 3–7 and there was increased staff knowledge, confidence and awareness of the team’s role.
Conclusion. The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes.
Relevance to clinical practice. This study highlights the importance of inter‐disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter‐disciplinary practice, supported by communication and data management that can be replicated across other patient groups.</description><identifier>ISSN: 0962-1067</identifier><identifier>EISSN: 1365-2702</identifier><identifier>DOI: 10.1111/j.1365-2702.2009.03155.x</identifier><identifier>PMID: 20345835</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Clinical medicine ; Clinical outcomes ; Female ; Focus Groups ; Humans ; Intensive care ; Intensive Care Units ; inter-disciplinary team ; Length of Stay ; Male ; Medical procedures ; Middle Aged ; mixed method evaluation ; New South Wales ; nurses ; Nursing ; Patient Care Team ; Quality of care ; Throat ; Tracheostomy</subject><ispartof>Journal of clinical nursing, 2010-05, Vol.19 (9-10), p.1275-1283</ispartof><rights>2010 Blackwell Publishing Ltd</rights><rights>Copyright Blackwell Publishing Ltd. May 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4665-136ed9b72d95eeffd728bba5b33ac344b7193c6180b9e85b8b1bc341994005af3</citedby><cites>FETCH-LOGICAL-c4665-136ed9b72d95eeffd728bba5b33ac344b7193c6180b9e85b8b1bc341994005af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2702.2009.03155.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2702.2009.03155.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20345835$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parker, Vicki</creatorcontrib><creatorcontrib>Giles, Michelle</creatorcontrib><creatorcontrib>Shylan, Gai</creatorcontrib><creatorcontrib>Austin, Nicole</creatorcontrib><creatorcontrib>Smith, Kelvin</creatorcontrib><creatorcontrib>Morison, Jane</creatorcontrib><creatorcontrib>Archer, Wendy</creatorcontrib><title>Tracheostomy management in Acute Care Facilities - a matter of teamwork</title><title>Journal of clinical nursing</title><addtitle>J Clin Nurs</addtitle><description>Aim. Implement and evaluate an inter‐disciplinary team approach to tracheostomy management in non‐critical care.
Background. Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient’s destination after ICU.
Design. A mixed method evaluation incorporating quantitative and qualitative approaches.
Method. Data collection included pre‐implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis.
Results. Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50–27 days (p < 0·0001) and an increase in the number of tracheostomy patients transferred to non‐critical care wards in the postgroup (p = 0·006). The number of wards accepting patients from ICU increased from 3–7 and there was increased staff knowledge, confidence and awareness of the team’s role.
Conclusion. The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes.
Relevance to clinical practice. This study highlights the importance of inter‐disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter‐disciplinary practice, supported by communication and data management that can be replicated across other patient groups.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clinical medicine</subject><subject>Clinical outcomes</subject><subject>Female</subject><subject>Focus Groups</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>inter-disciplinary team</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical procedures</subject><subject>Middle Aged</subject><subject>mixed method evaluation</subject><subject>New South Wales</subject><subject>nurses</subject><subject>Nursing</subject><subject>Patient Care Team</subject><subject>Quality of care</subject><subject>Throat</subject><subject>Tracheostomy</subject><issn>0962-1067</issn><issn>1365-2702</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV2P1CAUhonRuOPqXzDEG69agVNKuTHZNO6o2Y8Y1-gdgc6pdrYfK9DszL-XOutceKPcQODh4XBeQihnOU_jzTbnUMpMKCZywZjOGXAp890jsjoePCYrpkuRcVaqE_IshC1jHISAp-REMChkBXJF1jfeNj9wCnEa9nSwo_2OA46RdiM9a-aItLYe6bltur6LHQaaUZu4GNHTqaUR7XA_-dvn5Elr-4AvHuZT8uX83U39Pru4Xn-ozy6ypihTYak63GinxEZLxLbdKFE5Z6UDsA0UhVNcQ1PyijmNlXSV4y7tc60LxqRt4ZS8Pnjv_PRzxhDN0IUG-96OOM3BVLxSUCmh_kkqAM6kAp3IV3-R22n2Y_qGESDTu5LLBFUHqPFTCB5bc-e7wfq94cwsoZitWXpvlt6bJRTzOxSzS1dfPvhnN-DmePFPCgl4ewDuux73_y02H6_rq2WZBNlB0IWIu6PA-ltTKlDSfL1am8v606X6_E2aNfwC7iun7g</recordid><startdate>201005</startdate><enddate>201005</enddate><creator>Parker, Vicki</creator><creator>Giles, Michelle</creator><creator>Shylan, Gai</creator><creator>Austin, Nicole</creator><creator>Smith, Kelvin</creator><creator>Morison, Jane</creator><creator>Archer, Wendy</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201005</creationdate><title>Tracheostomy management in Acute Care Facilities - a matter of teamwork</title><author>Parker, Vicki ; Giles, Michelle ; Shylan, Gai ; Austin, Nicole ; Smith, Kelvin ; Morison, Jane ; Archer, Wendy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4665-136ed9b72d95eeffd728bba5b33ac344b7193c6180b9e85b8b1bc341994005af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical medicine</topic><topic>Clinical outcomes</topic><topic>Female</topic><topic>Focus Groups</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>inter-disciplinary team</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical procedures</topic><topic>Middle Aged</topic><topic>mixed method evaluation</topic><topic>New South Wales</topic><topic>nurses</topic><topic>Nursing</topic><topic>Patient Care Team</topic><topic>Quality of care</topic><topic>Throat</topic><topic>Tracheostomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parker, Vicki</creatorcontrib><creatorcontrib>Giles, Michelle</creatorcontrib><creatorcontrib>Shylan, Gai</creatorcontrib><creatorcontrib>Austin, Nicole</creatorcontrib><creatorcontrib>Smith, Kelvin</creatorcontrib><creatorcontrib>Morison, Jane</creatorcontrib><creatorcontrib>Archer, Wendy</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parker, Vicki</au><au>Giles, Michelle</au><au>Shylan, Gai</au><au>Austin, Nicole</au><au>Smith, Kelvin</au><au>Morison, Jane</au><au>Archer, Wendy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tracheostomy management in Acute Care Facilities - a matter of teamwork</atitle><jtitle>Journal of clinical nursing</jtitle><addtitle>J Clin Nurs</addtitle><date>2010-05</date><risdate>2010</risdate><volume>19</volume><issue>9-10</issue><spage>1275</spage><epage>1283</epage><pages>1275-1283</pages><issn>0962-1067</issn><eissn>1365-2702</eissn><abstract>Aim. Implement and evaluate an inter‐disciplinary team approach to tracheostomy management in non‐critical care.
Background. Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient’s destination after ICU.
Design. A mixed method evaluation incorporating quantitative and qualitative approaches.
Method. Data collection included pre‐implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis.
Results. Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50–27 days (p < 0·0001) and an increase in the number of tracheostomy patients transferred to non‐critical care wards in the postgroup (p = 0·006). The number of wards accepting patients from ICU increased from 3–7 and there was increased staff knowledge, confidence and awareness of the team’s role.
Conclusion. The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes.
Relevance to clinical practice. This study highlights the importance of inter‐disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter‐disciplinary practice, supported by communication and data management that can be replicated across other patient groups.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20345835</pmid><doi>10.1111/j.1365-2702.2009.03155.x</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Clinical medicine Clinical outcomes Female Focus Groups Humans Intensive care Intensive Care Units inter-disciplinary team Length of Stay Male Medical procedures Middle Aged mixed method evaluation New South Wales nurses Nursing Patient Care Team Quality of care Throat Tracheostomy |
| title | Tracheostomy management in Acute Care Facilities - a matter of teamwork |
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