Creation of an Open Bedside Tracheostomy Program at a Community Hospital With a Single Surgeon

Abstract

Abstract Objective To assess the adverse event rate and operating cost of open bedside tracheostomy (OBT) at a community hospital. To present a model for creating an OBT program at a community hospital with a single surgeon. Study Design Retrospective case series pilot study. Setting Academic‐affiliated community hospital. Methods Retrospective chart review of surgical OBT and operating room tracheostomy (ORT) at a community hospital from 2016 to 2021. Primary outcomes included operation duration; perioperative, postoperative, and long‐term complications; and crude time‐based estimation of operating cost to the hospital using annual operating cost. Clinical outcomes of OBT were assessed with ORT as a comparison using t tests and Fisher's exact tests. Results Fifty‐five OBT and 14 ORT were identified. Intensive care unit (ICU) staff training in preparing for and assisting with OBT was successfully implemented by an Otolaryngologist and ICU nursing management. Operation duration was 20.3 minutes for OBT and 25.2 minutes for ORT (p = .14). Two percent, 18%, and 10% of OBT had perioperative, postoperative, and long‐term complications, respectively; this was comparable to rates for ORT (p = .10). The hospital saved a crude estimate of $1902 in operating costs per tracheostomy when performed in the ICU. Conclusion An OBT protocol can be successfully implemented at a single‐surgeon community hospital. We present a model for creating an OBT program at a community hospital with limited staff and resources.

Keywords

• community hospital
• cost effectiveness
• open bedside tracheostomy
• quality improvement