Evaluation of a virtual multidisciplinary tracheostomy meeting for ward-based patients

Abstract

Background

Tracheostomy is frequently performed in an intensive care unit setting to progress the care of intubated patients. A multidisciplinary team follows up tracheostomised patients once transferred to the ward. A virtual tracheostomy multidisciplinary meeting (MDM) was established with the aim to standardize care for these patients.

Methods

A retrospective review of ward-based patients discussed in a Tracheostomy MDM was performed at The Alfred Hospital, a tertiary hospital providing a state-wide trauma service. Two groups were compared; (i) Outreach group comprising patients who were managed prior to the establishment of the Tracheostomy MDM on the 26 July 2021; (ii) Virtual Tracheostomy MDM (V-MDM) group who were managed after the establishment of the Virtual Tracheostomy MDM. Primary outcome was decannulation time from ICU discharge.

Results

There were 65 patients in the Outreach group over 134 weeks. There were 44 patients in the V-MDM group over 94 weeks. There was a significant difference between groups in the median time to decannulation from ICU discharge (P = 0.007) and the overall time to decannulation (P = 0.029) with the V-MDM group requiring a longer period with tracheostomy prior to decannulation. There were no significant differences in the overall hospital length of stay (LOS) or rate of adverse events.

Conclusion

Implementing a supplemental Tracheostomy MDM in a virtual format may not improve time to decannulation and can possibly delay decannulation compared to an established tracheostomy team led by ICU clinicians. Virtual Tracheostomy MDM may have a role in managing patients were a non-virtual ICU-led team is not feasible.