Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes

Abstract

Background: Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. Problem: Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. Approach: A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. Outcomes: Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days (P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. Conclusions: This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.

Essential collaboration of advanced practice RN roles

“…After implementing an increased focus with CNS rounding and collaboration with NPs, length of stay decreased by 3 days, pressure injury associated with tracheostomy decreased from 5 to zero per year in 2 years, and a significant cost reduction was realized. 11 Examples of collaboration with direct patient care occur for patients with newly placed tra-cheostomies as well as long-term or chronic tracheostomies. One situation involved a middle-aged male patient with a muscular dystrophy who was admitted for tracheostomy.…”

“…This care coordination using a CNS to round on all patients with tracheostomies has resulted in decreased complications, decreased length of stay, and significant reductions in care costs. After implementing an increased focus with CNS rounding and collaboration with NPs, length of stay decreased by 3 days, pressure injury associated with tracheostomy decreased from 5 to zero per year in 2 years, and a significant cost reduction was realized 11…”

President's Message

“…In a recent report, CNSs effectively reduced LOS by 2.5 days at an estimated cost savings of $2.2 million 4 . These CNSs managed patients with tracheostomies that included procedures to downsize tracheostomy tubes and decannulation, took ownership of the discharge process, and coordinated care among the various disciplines.…”

Evaluation of tracheostomy suctioning procedure among nursing and respiratory therapy students: wearable manikin vs. standard manikin

“…Complications of tracheostomies include infection, hemorrhage, pneumothorax, aspiration, and development of granulation tissue ( 2 ). Many complications can be prevented by good tracheostomy care and management ( 3 , 4 ). In school, students typically learn about tracheostomy care with manikins through clinical simulations ( 5 ).…”