AARC Clinical Practice Guideline: Management of Adult Patients with Tracheostomy in the Acute Care Setting

Barriers to Discharge Patients With a Tracheostomy: A Qualitative Analysis

“…Evidence shows that tracheostomy order bundles, multidisciplinary care teams, and structured discharge processes promote safety and quality of care for patients and their caregivers. 1,2 Participants frequently cited a lack of communication between disciplines as a barrier to an effective discharge. Identification of this communication problem was consistent with a research study by Okoniewska et al, 7 which found that a lack of communication was a barrier to effective discharge.…”

“…The procedure is very consequential, and these patients are high consumers of health care resources and require multidisciplinary care teams for comprehensive care planning postoperatively and throughout the discharge process. 1,2 According to Cherney et al, 1 approximately 20% of patients with a tracheostomy are discharged home with the tracheostomy tube still in place. Considering their complexity and potential vulnerability, patients with a tracheostomy are at high risk for morbidity or unplanned readmissions.…”

Updates in percutaneous tracheostomy and gastrostomy: should we strive for combined placement during one procedure?

“…In short, multidisciplinary care teams are likely to improve time to decannulation, length of stay and tracheostomy-related cost. Further, tracheostomy weaning protocols may improve time to decannulation, hospital length of stay and tracheostomy-related cost [32 ▪ ]. Other benefits are possible but may be more difficult to measure given difficulty with randomization in this population.…”

AARC Clinical Practice Guidelines: Phase 4

“…This brings us to the fourth phase of AARC CPGs, the first of which are published in this issue of the Journal. 11,12 This is an important step forward. These guidelines have many of the required elements of evidence-based CPGs.…”

“…For example, the adult tracheostomy CPG recommends the use of a protocol to guide weaning and removal of the tracheostomy tube. 11 The details are left to local practice; a standardized approach (protocol) might be more important than the specific details. The pediatric tracheostomy CPG 12 recommends that tracheostomy tubes should be changed as needed secondary to obstruction, but the details of the tracheostomy tube change procedure are left to local practice.…”