Importance of Inter / Multidisciplinary Care in Physical Medicine and Rehabilitation in Acute Tracheostomized Patients: The Experience of a Service
DOI:
https://doi.org/10.25759/spmfr.250Keywords:
Patient Care Team, Tracheostomy/rehabilitationAbstract
Introduction: Patients discharged from the Intensive Care Units (ICU) with tracheostomy tubes in situ are increasing; optimal care of patients with tracheostomy is provided by inter/multidisciplinary care teams. This article makes a literature review and presents a study conducted at an Acute Patient Care Unit (APCU), cocoordinated by a Physiatrist.
Material and Methods: Data were collected retrospectively, for the 40 patients with tracheostomy admitted to the APCU from May 2011 to 2013. Reference department, mean age, main diagnosis, medical/ surgical pathology, time to decannulation, hospital length of stay, percentage of decannulations and discharge destination were recorded. Statistical analysis was performed for functional improvement in all patients and by subgroups (decannulated versus non decannulated). For literature review we searched MEDLINE database. A comparative analysis was performed between APCU outcomes and literature data.
Results: Forty patients with tracheostomy were admitted to the APCU. The average age was 59.6 years. 77.5% of patients were decannulated, 100% successfully. The mean time to decannulation was 35 days and the mean hospital length of stay was 60.9 days. Functional scores at admission date were statistically different from functional scores at discharge (p < 0.001), and decannulated patients have higher functional improvement than those who remained with a tracheostomy tube in situ (p = 0.023). Mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature.
Conclusion: Inter and multidisciplinary care model for patients with tracheostomy has a favourable impact. The APCU described represents a growing experience providing care for patients with tracheostomy. Decannulated APCU’s patients verified greater functional improvement than those who remained with a tracheostomy tube in situ. The mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature, probably due to higher severity-of-disease scores, more comorbidities and provide rehabilitation regardless predetermined hospital length of stay. APCU may be demonstrative of an innovative healthcare Physical Medicine and Rehabilitation (PRM) clinical area.
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