793

Abstract

Physicians were significantly more likely than nurses to have positive responses on their rating of Teamwork Climate (73.0% vs. 36.7%, p=0.004). Conclusions: Physicians and nurses rank Job Satisfaction highly. They give the lowest scores to Perceptions of Management and Working Conditions. For all six domains physicians give higher rankings for safety attitudes, indicating a systematic difference in perception. Nurses and physicians differ most markedly in their opinion of Teamwork Climate with physicians believing that teamwork is better than nurses do. These results could be used to improve working conditions, patient safety, and quality.Learning Objectives: Tracheostomy ties and post-procedural sutures are the standard of care in securing a newly created tracheostomy, as airway loss is life threatening. Sutures may prevent therapies for pressure sore reduction and may contribute to the reported 8% incidence of tracheostomy-related pressure ulcers. No study has evaluated the absence of sutures reducing tracheostomy-related pressure sores. The purpose of this study was to evaluate whether refraining from post-procedural percutaneous tracheostomy (PT) sutures reduced the incidence of pressure sores. In October, 2012 we changed our standard practice, eliminating routine post-procedural sutures in PT, and hypothesized that this would reduce the incidence of tracheostomy related pressure sores. Methods: This retrospective study was conducted in an urban Level 2 Trauma Center. All PT were performed by a dedicated tracheostomy team. All PTs performed in our MICU, SICU and CICU between January, 2010 and June, 2014 were included. Patient characteristics, preprocedural metrics, and outcomes were collected. Patients prior October 2012 had PT sutures placed (sutured group: SG). Sutures remained in place for 4 days and were removed by the team. After October, 2012, patients had no sutures (no sutures: NS). Device-related pressure sore detection was performed by ICU teams and confirmed by the hospital's wound team. Results:141 patients were included: 71 were sutured and 70 were not sutured. There was no significant difference in characteristics (mean age in years: SG 62, NS 61.3 (p=0.82), male gender: SG 42, NS 49 (p=0.46), BMI in kg/m2: SG 30.35, NS 29.53 (p=0.87)). Albumin at time of PT was significantly lower in the SG 2.43 g/dl, NS 2.64 g/dl (p<0.039). Patients without sutures had a statistically different incidence of device-related pressure ulcer related to tracheostomy (SG 6, NS 0 ulcers, p<0.001). Neither group experienced tube dislodgement during their hospital course. Conclusions: Refraining from placement of post-procedural sutures in PT appears to be safe and significantly reduced the incidence of PT related pressure sores in our series.