(120) Creation and Implementation of a Standardized Tracheostomy Discharge Checklist

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

Ryan T. Judd, MD

Resident
Ohio State University Hospital Program
Columbus, Ohio, United States

Co-Author(s)

Ladan Navari, Other

Medical Student
The Ohio State University
Columbus, OH, United States
AO

Annie J. Orr, MD

Resident
University of Missouri
Columbia, Missouri, United States
Alessandra J. Bliss, Other

Medical Student
The Ohio State University
Columbus, OH, USA
Kathleen Y. Bellamy, LISW, ACM-SW

Patient Care Resource Manager
The Ohio State University
Columbus, OH, United States

Senior Author(s)

Laura Matrka, MD

Professor, Department of Otolaryngology - Head and Neck Surgery
The Ohio State University
Columbus, OH, United States

Disclosure(s):

Ryan T. Judd, MD: No relevant relationships to disclose.

Ladan Navari, Other: No relevant relationships to disclose.

Annie J. Orr, MD: No relevant relationships to disclose.

Kathleen Y. Bellamy, LISW, ACM-SW: No relevant relationships to disclose.

Introduction: Discharge of patients with newly placed tracheostomies requires a consistent, interdisciplinary approach to prevent potentially life-threatening complications. Recent guidelines have provided a framework for safe and effective discharge after tracheostomy. We present a quality improvement initiative to identify and address gaps in the discharge planning for patients with newly-placed tracheostomies.

Methods: Retrospective review of patients with surgical tracheostomy by an otolaryngologist at the study institution from 2019-2021 who were discharged to home. Based on identified gaps, we formed a multidisciplinary team of physicians, residents, and case managers to create a standardized discharge card. We then performed a short-term interval analysis of the first patients discharged with the discharge card.

Results: In our retrospective review of 155 patients prior to the quality improvement, discharge instructions did not contain information on tracheostomy type or re-insertion steps in case of decannulation in 112 (72.3%) and 147 (94.8%), respectively. Patients were discharged without suction, humidification, or a backup trach in 18 (11.6%), 29 (18.7%), and 22 (14.2%) instances, respectively. Follow-up with a tracheostomy provider was not scheduled for 22 (14.2%). A standardized tracheostomy discharge card was created, which includes instructions about use of humidification, suction, and vital supplies, and instruction in case of trach dislodgement. Trach size and type and contact numbers for the equipment company, physician, and case manager were also included. Twelve consecutive patients were discharged to home with the discharge card, and all 12 (100%) had suction, humidification, and a backup trach prescribed, follow up scheduled, and information on trach type and re-insertion steps.

Conclusions: Significant gaps in home discharge planning for patients with newly placed tracheostomy exist and can be addressed with the use of a simple, standardized tracheostomy discharge card.