Many of these tracheostomy patients commence their care in the intensive care unit (ICU) and once stabilised are transferred to a general ward. Insufficient skills and experience of staff caring for tracheostomy patients may lead to suboptimal care and increased morbidity.To facilitate the improvement of care of patients with tracheostomy, Southern Health, Clayton, done Victoria, Australia, is interested in planning a multidisciplinary outreach service to care for tracheostomy patients discharged from the ICU to the wards. To inform this process the Centre for Clinical Effectiveness was requested to undertake a systematic review to identify whether or not multidisciplinary tracheostomy outreach teams compared with standard care enable the reduction in time to decannulation and length of stay in acute and sub-acute settings, improve quality of care or decrease adverse events for these patients.

Materials and methodsSearch strategyIn June 2009, we conducted a search for any comparative study written in English from 1980 onwards. We searched Medline using the following search strategy: (exp Tracheostomy/OR exp Tracheotomy/OR (tracheostom$ OR tracheotom$).mp. OR (trachea AND stoma).mp.) AND ((exp Patient Care Team/OR “patient care team”.mp.) OR exp “Continuity of Patient Care”/OR exp Patient Care Planning/OR exp Case Management/OR exp Patient Care Management/OR exp “Delivery of Health Care, Integrated”/OR exp Patient-Centered Care/OR (Case-management OR care-coordination OR care-co-ordination OR care-planning).mp.

OR (Multidisciplin$ OR multi-disciplin$ OR multiprofessional OR multi-professional OR interdisciplin$ OR inter-disciplin$ OR (multi$ AND profession$)).mp. OR (team$ OR service$).mp.)Similar terms appropriately translated were used in EMBASE, All EBM and CINAHL. Studies were selected and appraised by two reviewers in consultation with colleagues using study selection and appraisal criteria established a priori.Inclusion criteriaThe following inclusion criteria were applied to all studies identified.Patient group included all tracheostomy patients, adults and/or children, from any age group, in a hospital ward setting. Intervention was multidisciplinary care. Comparator was standard care. Outcomes were average time to decannulation, length of stay, quality of care, and adverse events.

Quality assessmentThe quality of included Brefeldin_A cohort studies was appraised using the standard critical appraisal questions developed by the Centre for Clinical Effectiveness. Critical appraisal questions are outlined in Table Table11.Table 1Critical appraisal questions for a cohort studyMissing dataAuthors of included studies were contacted by email with any queries.ResultsSearch resultsThe search of all databases returned 1045 articles, which were reviewed by title and abstract. When a decision could not be made based on abstract alone, full text was retrieved.