The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration
The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration
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Trach Trail：提高气管切开护理质量和跨学科合作的基于系统的途径
DOI：
10.1177/0194599820917427
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发表时间：
2020-05-26
影响因子：
3.4
通讯作者：
Brenner, Michael J.
中科院分区：
文献类型：
--
作者：
Cherney, Rebecca L.;Pandian, Vinciya;Brenner, Michael J.
目的通过气管切开术教育、协调护理方案和跟踪患者预后，实现标准化气管切开术路径，减少住院时间。方法：项目设计包括基线状态的回顾性分析，随后是多模式干预（trace Trail）和与同步对照的前瞻性比较。分析2015年至2016年气管切开术患者（n = 60）的人口统计学和结局。Trach Trail是一种标准化的护理途径，是根据爱荷华州循证实践模型开发的。trace Trail的实施需要每月进行为期8小时的气管切开术冠军培训，以及工作人员护理教学、书面材料和体验式学习。Trach Trail的登记时间为2018年至2019年。收集Trach Trail组（n = 21）和同步气管切开术对照组（n = 117）患者的人口统计学、住院时间和护理结果数据。结果55名护士完成了气管切开术培训，为21例气管切开术患者提供护理，同时对照气管切开术患者接受常规气管切开术护理。Trach Trail组和对照组的患者具有相似的人口统计学特征、诊断和气管切开术指征。与对照组相比，Trach Trail组重症监护病房的住院时间明显缩短，从平均21天减少到10天（P < 0.05）。不良事件的发生率没有变化。引入气管导管与减少重症监护病房的住院时间有关。实现更广泛的以患者为中心的改善可能需要呼吸治疗师、语言病理学家和社会工作者的参与，以最大限度地提高患者/护理人员的参与度。标准化的气管切开术护理与跨学科合作可以缩短住院时间，改善患者的预后。
ObjectiveTo implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes.MethodsThe project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117).ResultsFifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged.DiscussionIntroduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement.Implications for PracticeStandardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.