TRAMS Austin Health :: Tracheostomy Care

A tracheostomy tube facilitates clearance of bronchial secretions, bypasses upper airway obstruction, allows weaning from mechanical ventilation and earlier discharge from the intensive care unit (1,2)

Associated risks include sputum plugging, loss of artificial airway, tracheal stenosis, infection and bleeding (2,3)

A tracheostomy tube can result in communication difficulties, patient distress and discomfort, and can delay patient discharge

Patients who have a tracheostomy tube are often cared for on wards outside of the ICU where staff-patient ratios are lower and specialist expertise may be less available (4,5)

Tracheostomy care requires input from a number of disciplines (4,7)

Background to TRAMS

	Prior to September 2002, there were no interdisciplinary protocols, very little specific tracheostomy education and no formal, dedicated team in place to coordinate and direct tracheostomy care across the centre.
	Trams Austin hypothesised that a coordinated approach to tracheostomy care would improve patient outcomes.
	Evidence supporting this hypothesis is scant and conflicting (4,6,7)
	We developed a Tracheostomy Review and Management Service (TRAMS), which is now an integral part of patient care at Austin Health.

Publications

	Cameron, T., McKinstry, A., Burt, S., Howard, M., Bellomo, R., Brown, D. J., Ross, J., Sweeney, J. and O'Donoghue, F. (2009). "Outcomes of patients with spinal cord injury before and after the introduction of an interdisciplinary tracheostomy team", Critical Care and Resuscitation, 11 (1), 14-19. http://www.tracheostomyteam.org/admin/For_Healthcare_Providers/Docs/ccr_11_1_010309-014_Cameron.pdf
	Cameron, T. Tracheostomy care resources; A guide to the creation of site specific tracheostomy procedures and education Austin Health Tracheostomy Review and Management Service (TRAMS) 2006 ISBN 0-9775686-0-1

Innovations

	Tracheostomy Care Resources: A Guide to the Creation of Site specific Tracheostomy Procedures and Education (8)
	Tracheostomy e-Learning Packages CD Rom (9)
	Tracheostomy Clinical Instruction Sheets (8)
	TRAMS Tracheostomy Training Program to assist other institutions with the creation of tracheostomy teams, competency training and ongoing education
	National and international workshops and presentations

References

1.	Tobin, A. and Santamaria, J. (2008). An intensivist led tracheostomy review team is associated with shorter decannulation times and length of stay. Critical Care, 12, R:48
2.	Durbin CG, Jr. Early complications of tracheostomy. Respir Care. 2005;50(4):511-515.
3.	Epstein SK. Late complications of tracheostomy. Respir Care. 2005;50(4):542-549.
4.	Norwood MG, Spiers P, Bailiss J, Sayers RD. Evaluation undefinedof the role of a specialist tracheostomy service. From critical care to outreach and beyond. Postgrad Med J 2004;80(946):478-480.
5.	Gentile MA, Wahidi MM. Tracheostomy in mechanically ventilated patients: unanswered questions. Critical Care Medicine 2005;33(2):444-445.
6.	Hunt K, McGowan S. Tracheostomy management in the neurosciences: a systematic, multidisciplinary approach. British Journal of Neuroscience Nursing 2005;1(3):122-125.
7.	Frank, U., Mader, M. , Sticher H. Dysphagic patients with tracheostomies: a multidisciplinary approach to treatment and decannulation management. Dysphagia. 2007;22:20-29
8.	Cameron, T. Tracheostomy care resources; A guide to the creation of site specific tracheostomy procedures and education Austin Health Tracheostomy Review and Management Service (TRAMS) 2006 ISBN 0-9775686-0-1
9.	Cameron, T. TRAMS e-Learning Packages: Humidification; Stoma Care; Measuring Cuff Pressure; Use of the Passy-Muir Valve ISBN 0-9775686-1-X

10	Tobin, A. (2009). Tracheostomy teams - filling a void (Editorial). Critical Care and Resuscitation, 11 (1), 3-6.

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