Tracheostomies are routinely performed in critically ill patients for various reasons including, long-term mechanical ventilation, airway obstruction, difficulties with airway protection, and trauma (McCormick, Ward, Roberson, Shah, Stachler, & Brenner, 2015; Mehta & Mehta, 2017). Percutaneous dilatational tracheostomy (PDT) is considered safer and more cost-effective, with fewer complications than surgical open tracheostomy (OT) (Mehta & Mehta, 2017; Yang et al., 2017). This common procedure has limited data regarding patients’ home management or follow-up in outpatient settings for the care of tracheostomies. Studies examining quality of life in patients undergoing a tracheostomy continue to reveal poor impacts on patient’s mental health (McCormick et al., 2015). The need for standardization of post discharge follow-up, thorough patient education, and availability of community resources is critical for patients with a tracheostomy (McCormick et al., 2015; Rai, Holler, Propst, Wolter, Amin, 2018). In order to provide proper management, there is a greater need to understand the current practice, long-term issues, and quality of life from the patients’ perspective. Therefore, the purpose of this study is to understand long term follow-up care of patients requiring inpatient tracheostomy. There is a need for standardizing follow-up tracheostomy patients post discharge to optimize support and continuing care.
Methods:
The cohort included patients who underwent a tracheostomy at our institution and were alive at the time of the survey. Patients who received a tracheostomy between 2007 and 2018 in our institution’s databases were chosen for this study. To date, 711 patients were identified who received a tracheostomy within the study timeframe, however, according to institutional patient databases, 225 were found to be deceased. Fifty-four % (266) of the 486 potential candidates were unreachable by telephone due to an incorrect or out of service number; 170 candidates (64%) were left a voicemail and did not respond. Out of the 220 patients who were contacted, 116 (53%) participated in the survey. Telephone calls were made from the institution by a team of callers assessing patient characteristics, follow-up characteristics, long-term issues, tracheostomy care practices, and quality of life variables. The survey used was developed by the study team, asking specific questions related to the follow-up care of the patient. The SF-12® Health Survey (Medical Outcomes Trust and QualityMetric Incorporated) was also utilized.
Results:
Data to date show that of the 116 patients who participated in the survey, 66 (57%) were men and 50 (43%) were women. Seventy-five (65%) underwent open tracheostomy (OT) while forty-one (35%) had percutaneous dilatational tracheostomies (PDT). Eighty-four (72%) of the participants received follow-up care, and thirty-four (40%) of these patients who received follow-up care had undergone PDT and fifty (60%) had OT. OT patients were more likely to follow-up with a general surgeon (13 [17.33%]), those who had PDT sought to follow-up with ENT (18 [43.9%]). Most of the patients in each of the two groups (OT vs. PDT) admitted to a follow-up consult with their respective doctors within one month from the day of discharge from the hospital (thirty-four [50%] OT and twenty-six [68%] PDT). Although the frequency of follow-up visits varied among OT and PDT patients, thirty-six (48%) of OT patients admitted to never receiving follow-up care.
Conclusion:
Although tracheostomies are commonly performed, little is known regarding patients’ home management or follow-up in outpatient settings for the care of tracheostomies. Through understanding patients’ follow-up behaviors, standardization of post discharge follow-up care and education can be implemented.