Int J Lang Commun Disord. 2019 Sep 30. doi: 10.1111/1460-6984.12504. [Epub ahead of print] Evaluation of a tracheostomy education programme for speech-language therapists. Miles A(1), Greig L(2), Jackson B(1), Keesing M(3). Author information: (1)Speech Science, The University of Auckland, Auckland, New Zealand. (2)The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand. (3)Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand. BACKGROUND: Tracheostomy management is considered an area of advanced practice for speech-language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development. AIMS: To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults. METHODS & PROCEDURES: A total of 35 SLTs participated in the programme, which included a 1-day tracheostomy simulation-based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part-task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non-medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self-perceived confidence rated prior, immediately post and 4 months post-workshop. OUTCOMES & RESULTS: SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post-workshop and maintained at 4 months. CONCLUSIONS & IMPLICATIONS: Postgraduate tracheostomy education, using a flipped-classroom approach and low- and high-fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well-received method of learning. © 2019 Royal College of Speech and Language Therapists. DOI: 10.1111/1460-6984.12504 PMID: 31566861
Critical Care Medicine. Publish Ahead of Print:, AUGUST 8, 2019
One-year outcomes following tracheostomy for acute respiratory failure
Anuj Mehta;Allan Walkey;Douglas Curran-Everett;Ivor Douglas;
Objectives:Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation.
Design:Retrospective cohort study.Setting:All California hospital discharges from 2012 to 2013 with follow-up through 2014.Patients:Nonsurgical patients who received a tracheostomy for acute respiratory failure.
Measurements and Main Results:Our primary outcome was 30-day, 90-day, and 1-year mortality. We also determined hospitals readmissions rates and healthcare utilization in the first year following tracheostomy. We identified 8,343 tracheostomies during the study period. One-year mortality following tracheostomy was high, 46.5%. Older adults (≥ 65 yr) had significantly higher mortality compared with younger patients (< 65 yr) (54.7% vs 36.5%; p < 0.0001). Median survival for older adults was 175 days (95% CI, 150–202 d) compared with greater than 1 year for younger adults (adjusted hazard ratio, 1.25; 95% CI, 1.14–1.36). Within 1 year of tracheostomy, 60.3% of patients required hospital readmission. Older adults were more likely to be readmitted in the first year after tracheostomy compared with younger adults (66.1% vs 55.2%; adjusted hazard ratio, 1.19; 95% CI, 1.09–1.29). Total short-term acute care hospital costs (index and readmissions) in the first year after tracheostomy were high (mean, $215,369; SD, $160,874).
Conclusions:Long-term outcomes following tracheostomy are extremely poor with high mortality, morbidity, and healthcare resource utilization especially among older patients. Some subsets of younger patients may have better outcomes compared with the general tracheostomy population. Short-term acute care costs were extremely high in the first year following tracheostomy. If extended to the entire U.S. population, total short-term acute care hospital costs approach $11 billion dollars per year for tracheostomy-related to acute respiratory failure. These findings may aid families and surrogates in the decision-making process.
PLoS One. 2019 Oct 2;14(10):e0220399. doi: 10.1371/journal.pone.0220399. eCollection 2019. Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation. Cinotti R(1), Voicu S(2), Jaber S(3), Chousterman B(4)(5), Paugam-Burtz C(6), Oueslati H(7), Damoisel C(5), Caillard A(4)(5), Roquilly A(1)(8), Feuillet F(9), Mebazaa A(4)(5), Gayat E(4)(5); FROG-ICU investigators. Author information: (1)Department of Anaesthesia and Critical Care, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France. (2)Department of Medical and Toxicological Intensive Care, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France. (3)Department of Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, University Hospital of Montpellier, France. (4)INSERM UMR 942 "Biocanvass", Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, France. (5)Department of Anaesthesia and Critical Care, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France. (6)Department of Anesthesia and Critical care department, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France. (7)Department of Anesthesia and Critical care department, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France. (8)Laboratoire UPRES EA 3826 « Thérapeutiques cliniques et expérimentales des infections », University hospital of Nantes, Bio-Ouest, Institut de la Recherche, Nantes, France. (9)INSERM UMR 1246 -SPHERE « Methods in Patient-Centered Outcomes and Health Research », Institut de la Recherche, Nantes, France. INTRODUCTION: In critically ill patients undergoing prolonged mechanical ventilation (MV), the difference in long-term outcomes between patients with or without tracheostomy remains unexplored. METHODS: Ancillary study of a prospective international multicentre observational cohort in 21 centres in France and Belgium, including 2087 patients, with a one-year follow-up after admission. We included patients with a MV duration ≥10 days, with or without tracheostomy. We explored the one-year mortality with a classical Cox regression model (adjustment on age, SAPS II, baseline diagnosis and withdrawal of life-sustaining therapies) and a Cox regression model using tracheostomy as a time-dependant variable. RESULTS: 29.5% patients underwent prolonged MV, out of which 25.6% received tracheostomy and 74.4% did not. At one-year, 45.2% patients had died in the tracheostomy group and 51.5% patients had died in the group without tracheostomy (p = 0.001). In the Cox-adjusted regression model, tracheostomy was not associated with improved one-year outcome (HR CI95 0.7 [0.5-1.001], p = 0.051), as well as in the model using tracheostomy as a time-dependent variable (OR CI 95 1 [0.7-1.4], p = 0.9). CONCLUSIONS: In our study, there was no statistically significant difference in the one-year mortality of patients undergoing prolonged MV when receiving tracheostomy or not. TRIAL REGISTRATION: NCT01367093. DOI: 10.1371/journal.pone.0220399 PMID: 31577804 Conflict of interest statement: Samir Jaber is consultant for Drager, Fisher-Paykel, Xenios and Medtronic. The other authors have no financial disclosures and no conflict of interest to declare about this work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.