Intensive care unit procedures: cost savings and patient safety

Intensive Care unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG). Although advances in ICU airway management include percutaneous tracheostomy, semi-open tracheostomy and conventional tracheostomy, the majority of critically ill surgical and injured patients still receive open tracheostomy in the Operating Room at Duke University Medical Center (DUMC). Although percutaneous tracheostomy is performed routinely in many medical ICU settings, in high risk surgical and trauma patients who often have unstable cervical spine injury and tissue edema, direct visualization of the cervical structures and trachea is imperative during tracheostomy. We have undertaken open tracheostomy and PEG in the ICU in selected patients as part of a collaborative, multidisciplinary ICU patient management strategy at DUMC. This initiative has been undertaken to address the risk of patient transport, the inappropriate use of OR time, and the cost to the patient as part of an effort to standardize and improve patient care.