AI Article Synopsis

  • The study aimed to evaluate the effectiveness of new protocols for using speaking valves (SV) in patients with tracheostomies at a major medical center, focusing on increasing usage and reducing wait times for trials.
  • A retrospective analysis of 421 patients showed that after implementing these protocols, the percentage of eligible patients trying SV increased from 75% to 95%, and those succeeding on their first attempt rose from 60% to 75%.
  • The findings suggest that the new protocols led to an 80% reduction in the time required for SV placement, highlighting the need for continued improvements in tracheostomy care practices.

Article Abstract

Objective: To review speaking valve (SV) use at a tertiary academic medical center and determine whether a multidisciplinary team implementation of SV protocols increased SV use and decreased time to SV trials.

Methods: Retrospective case series of patients who underwent a tracheostomy between 2017 and 2023 before and after the dissemination of new protocols from a new multidisciplinary tracheostomy care initiative in 2019. The calendar days between meeting SV eligibility criteria and initial trial of SV were compared. Eligibility criteria for SV was defined as any patient ≥48 hours posttracheotomy who can breathe unassisted, off mechanical ventilation, tolerate a deflated cuff, and participate in an evaluation. Interrupted time series analysis using segmented negative binomial regression assessed the change in time to SV placement before and after protocol implementation.

Results: A total of 421 patients were identified. After new protocols were disseminated, eligible patients with a SV trial increased from 75% to 95% with an increase in percentage of patients who tolerated the SV on their first attempt from 60% to 75%. Interrupted time series analysis demonstrated protocol implementation was associated with an overall 80% decrease in time to SV placement.

Discussion: Continued barriers to SV implementation such as elevated tracheal pressures due to large tracheostomy sizes, or inappropriately early consultations with patients unable to participate in SV exam, may be amenable to further institution-level quality improvement initiatives.

Implications For Practice: A multidisciplinary initiative's dissemination of protocols with algorithms for SLP consultation and SV use can help standardize post-operative tracheostomy care.

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Source
http://dx.doi.org/10.1002/ohn.1016DOI Listing

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