Implementation of Screening Tool to Trigger Tracheostomy Decannulation Evaluation by Otolaryngology

Abstract

Background: Tracheostomy is a common surgical procedure increasing in prevalence, particularly amid the COVID-19 pandemic. Otolaryngology is often consulted for upper airway evaluation prior to initiating capping trials designed to simulate decannulation readiness. A 22- bed adult long-term acute care hospital (LTACH) recognized an increase in inappropriate Otolaryngology consultations to 20%. At that time, the project site was not utilizing a standardized screening to determine need for consultation. Inappropriate consults led to increased health care costs, provider inefficiencies, and unnecessary patient evaluations. This quality improvement (QI) project sought to develop, implement, and evaluate the success of a tracheostomy decannulation readiness screening tool comprised of eight evidence-based clinical parameters. Methods: Pulmonology providers received training on screening tool utilization prior to implementation. Between September and December 2022, the screening tool was utilized weekly by the Pulmonology team. Otolaryngology was consulted if all parameters were met. Chart audits measured screening tool utilization and appropriate consultation. The overall percentage of inappropriate Otolaryngology consultations and mean length of stay (LOS) were measured. Results: One hundred forty-five screening opportunities were identified among 21 eligible patients, which resulted in 100% compliance with weekly screening. Patients who passed screening (n=6) received an Otolaryngology consultation and capping was recommended for 100% of these patients. There were no inappropriate Otolaryngology consultations during implementation. Pre-implementation mean length of stay (LOS) was 111.9 days which decreased to 92.1 days post-implementation. Conclusions: The screening tool accurately identified patients appropriate for Otolaryngology consultation. Overall, the screening tool improves efficiency, reduces health care costs, decreases LOS, and decreases inappropriate Otolaryngology consultations.