Creation of an Open Bedside Tracheostomy Program at a Community Hospital With a Single Surgeon

Abstract

Objective To assess the adverse event rate and operating cost of open bedside tracheostomy (OBT) at a community hospital. To present a model for creating an OBT program at a community hospital with a single surgeon. Study Design Retrospective case series pilot study. Setting Academic‐affiliated community hospital. Methods Retrospective chart review of surgical OBT and operating room tracheostomy (ORT) at a community hospital from 2016 to 2021. Primary outcomes included operation duration; perioperative, postoperative, and long‐term complications; and crude time‐based estimation of operating cost to the hospital using annual operating cost. Clinical outcomes of OBT were assessed with ORT as a comparison using t tests and Fisher's exact tests. Results Fifty‐five OBT and 14 ORT were identified. Intensive care unit (ICU) staff training in preparing for and assisting with OBT was successfully implemented by an Otolaryngologist and ICU nursing management. Operation duration was 20.3 minutes for OBT and 25.2 minutes for ORT ( p = .14). Two percent, 18%, and 10% of OBT had perioperative, postoperative, and long‐term complications, respectively; this was comparable to rates for ORT ( p = .10). The hospital saved a crude estimate of $1902 in operating costs per tracheostomy when performed in the ICU. Conclusion An OBT protocol can be successfully implemented at a single‐surgeon community hospital. We present a model for creating an OBT program at a community hospital with limited staff and resources.

Bedside open tracheostomy in COVID-19 patients - a safe and swift approach

“…Other studies also demonstrated positive outcomes while also showing that open methods can have less cost than percutaneous methods ( 8 , 9 ). In addition, a recent retrospective study showed open bedside tracheostomy in ICU had shorter operating times, similar complication rates and a crude cost saving of approximately $1900 compared to tracheostomy performed in theatre ( 10 ). Favourable outcomes were also demonstrated in another study with a lower cost compared to percutaneous dilatational tracheostomy ( 8 ).…”

Response to Open Bedside Tracheostomy Practical Tips

“…Pressing for "avoidance of high-risk sexual activity [as] championed by the otolaryngologist" can come across as patronizing and shaming, potentially straining the patientphysician relationship. Abstinence-only education falls short in practice, 2 and the disconnect here leads to adverse health outcomes. Connecting patients with resources for safe sexual practices may prove more effective than simply advising avoidance.…”

“…As you nicely describe, this type of tracheostomy can be performed when safety concerns regarding transferring patients out of the intensive care unit, such as during the Covid 19 pandemic 1 . We have also described a protocol for performing bedside tracheostomies in many settings: a resource rich academic medical center, a public funded county hospital an"d a community‐based hospital with a single surgeon 2 . Thank you for highlighting training of the staff is vital to success but can be easily achieved.…”