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.