Outcomes of dysphagia intervention in a pulmonary rehabilitation program.

People with chronic obstructive pulmonary disease (COPD) or chronic respiratory disease demonstrate an increased prevalence of oropharyngeal dysphagia as a consequence of impaired coordination between respiration and swallowing function. To date, the effect of patient education and intervention on the management of oropharyngeal dysphagia within pulmonary rehabilitation programs has not been reported or evaluated. Data were collected on participants who were enrolled in the Outpatient Pulmonary Rehabilitation Program and who received dysphagia intervention. Intervention consisted of some or all of the following: (1) a 1-hour dysphagia education program, (2) screening for oropharyngeal dysphagia, and (3) individual comprehensive oropharyngeal dysphagia assessment and management if a screening assessment was failed. A statistically significant improvement was found in participants' knowledge of dysphagia and COPD (P < 0.001). Participants' retention of this knowledge 4 days post education remained statistically significant (P < 0.001). Twenty-seven percent of participants who were screened had symptoms of oropharyngeal dysphagia. Fifty-five (53%) participants receiving further individual dysphagia assessment/management correctly completed pre/post swallowing-related quality-of-life surveys (SWAL-QOL). Statistically significant improvement was found in the following subscales: Burden of Dysphagia (P < 0.009), Physical Problems of Dysphagia (P < 0.012) and Managing Diet Options/Food Selection (P < 0.016). Dysphagia education, screening, and management in a pulmonary rehabilitation program improved participants' swallowing-related quality of life and overall self-management of chronic respiratory disease and dysphagia.

Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team.

OBJECTIVES: To assess outcomes in patients with spinal cord injury (SCI) and a tracheostomy tube (TT), before and after the introduction of a tracheostomy review and management service (TRAMS) for ward-based patients. DESIGN: Matched-pairs design with two cohorts, before and after the intervention. SETTING: 900-bed tertiary hospital in Melbourne, Victoria. PARTICIPANTS: SCI patients with a TT that was removed: 34 patients in the post-TRAMS period (September 2003 to September 2006) were matched to 34 from the pre-TRAMS period (September 1999 to December 2001). INTERVENTION: TRAMS was introduced as a consultative team of specialist physicians, clinical nurse consultants, physiotherapists and speech pathologists. The team coordinated tracheostomy care, conducted twice-weekly rounds, and provided policy, education, and support. MAIN OUTCOME MEASURES: Comparison of length of stay (LOS), duration of cannulation (DOC), improved communication through use of a one-way valve, number of adverse events and related costs. RESULTS: Median patient LOS decreased from 60 days (interquartile range [IQR], 38-106) to 41.5 days (IQR, 29- 62) (P = 0.03). The pre-TRAMS median DOC decreased from 22.5 days (IQR, 17-58) to 16.5 days (IQR, 12-25) (P = 0.08). Speaking-valve use increased from 35% (12/34) to 82% (28/34) (P < 0.01). Median time to a valve trial decreased from 22 days (IQR, 13-44) to 6 days (IQR, 4-10) after TT insertion (P < 0.01). There were two tracheostomy-related medical emergency calls pre-TRAMS and none post-TRAMS. There were no tracheostomy-related deaths in either group. The annual cost savings from implementing TRAMS were about eight times greater than the cost of service provision. CONCLUSION: Implementing a tracheostomy review and management service improved outcomes for SCI patients: they left acute care sooner, spoke sooner, and the TT was removed earlier, with associated cost savings.