(114) Impact of a Multidisciplinary Educational Initiative on Tracheostomy Outcomes in Trauma Patients: A Follow-Up Study

Introduction: Tracheostomy is a common procedure in the trauma care setting; however, outcomes may differ when variability exists in technique and post-operative management. A prior study at the Puerto Rico Medical Center (PRMC) identified higher complication rates among patients undergoing percutaneous tracheostomy and those with larger initial tracheostomy tube sizes (ITTS-8). In response, a multidisciplinary intervention was implemented in 2021 to educate personnel from PRMC on the best practices in tracheostomy care.

Methods: We conducted a retrospective chart review of 63 adult trauma patients who underwent tracheostomy at PRMC between 2021–2023. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using chi square and Fisher's test for categorical variables.

Results: The analyzed data show no significant shift toward OT approach (from 50.4% to 50.8%). However, there was a significant preference for smaller initial tube sizes (ITTS-6), which increased from 40.7% to 77.8%. In addition, fewer complications were documented. Notably, abnormal flexible laryngoscopy findings associated with the percutaneous approach decreased from 77.6% to 38.7% (p < 0.05), and from 72.1% to 42.9% (p < 0.05) with the ITTS-8. Compared to the pre-intervention cohort, the post-intervention group had a higher rate of successful decannulation (56.3% vs 61.9%), and fewer delays related to airway complications.

Conclusions: Our findings suggest that a targeted educational initiative can reduce tracheostomy-related complications and support more consistent, evidence-based care. A targeted educational initiative reduced complications; however, it was unable to promote a standardized tracheostomy care. These results support continued multidisciplinary efforts to improve outcomes in trauma patients.