2021 Annual Conference

CNS Improving Outcomes
Quality Initiatives
Patient Populations
Capture Value of the CNS
Interprofessional Collaboration

     Tracheostomies are considered a low volume, high risk population, requiring a multidisciplinary collaborative approach. A multidisciplinary team within a Large Midwest hospital identified gaps in care being provided tracheostomy patients. These patients had increased complications, increased length of stay and delayed discharge readiness to home.  Through a formal care management focus with Clinical Nurse Specialists, a standardized rounding process was developed. CNS rounding three times per week provides advanced nursing support to both bedside nurses and patients. This process allowed the CNS to mentor bedside nurses in tracheostomy care.  One key strategy implemented was the use of a hand-held mirror to improve self-care and body image for patients with a new tracheostomy. Ongoing collaboration with home health care, speech and respiratory therapy to develop formal patient discharge education material including a hand-off tool from the hospital to home health care was also developed. 

     As a result of the standardized rounding was continuous positive feedback regarding perception of increased nursing confidence in management of complex tracheostomy.  Improved patient perception of trach self-care skills was realized through the use of the hand-held mirror. Patients had earlier decannulation rates, improved satisfaction and decreased complications.  HAPIs decreased from 5 to 1 as this process was fully implemented. The most significant improvement was an overall decrease in length of stay of more than 3 days. This results in a significant cost avoidance for the hospital. The CNS tracheostomy rounding has led to increased nursing comfort in caring for these patients as well as improved collaboration among all disciplines.  CNS driven care management including self-care and discharge readiness significantly decreased length of stay. Future efforts include the development of a CNS led trach clinic to provide out of hospital resources to this unique population between appointments to prevent risk of readmission.