Wellington Intensive Care Unit

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TRACHEOSTOMY REVIEW AND MANAGEMENT SERVICE (TRAMS)

Wellington ICU TRAMS
The Tracheostomy Review And Management Service is a multidisciplinary team developed in Wellington Hospital and is the first of its kind in New Zealand. It is based on the TRAMS system developed in the Austin Hospital in Melbourne in 2002 and manages the tracheostomies of all ward patients discharged from the Intensive Care Unit.

Tracheostomies were traditionally inserted by Ear, Nose & Throat (ENT) surgeons in the operating theatre. As the need for them in Intensive Care patients exceeded available operating time, percutaneous tracheostomies that can be inserted by Intensive Care Specialists at the bedside were developed and have now become commonplace.

Most tracheostomies placed in the ICU are removed by the medical staff before the patient leaves. However, in some cases where the tube is still required, the patient may be discharged to the ward with the tracheostomy still in place.

It has been recognised that decision making regarding troubleshooting and removal of these specialist airways is often delayed. The Austin Hospital were the first to describe a multidisciplinary approach to maximise safety and education regarding tracheostomy management in sometimes unfamiliar environments. Recognising this proactive approach to safety, a team with similar principles and intent was set up in Wellington Hospital in 2011.

The Wellington TRAMS team consists of:

  • An Intensive Care Specialist
  • A senior Physiotherapist
  • A senior Speech & Language Therapist
  • The Intensive Care Clinical Nurse Specialist

All patients discharged from Intensive Care with tracheostomies in-situ are followed-up in the ward until they are either discharged from Wellington Hospital or the tracheostomy is removed by the TRAMS team. These visits may be daily or less frequent depending on the acuity of the patient. Decision making regarding removal and changing of the tracheostomy is now managed by this expert team rather than, on occasion, junior doctors or nurses with little tracheostomy experience.
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TRAMS - An Allied Health Initiative
The Allied Health services website chose Wellington TRAMS as a 'showcase innovation' in 2014.

A short interview with Kerryn (Physiotherapy) & Molly (SLT Team Leader) talking about TRAMS, can be seen below:

All decisions regarding tracheostomies are made in conjunction with each patient's named medical team. TRAMS only follow up patients with tracheostomies inserted by the Intensive Care team. Surgically inserted tracheostomies remain under the care of the ENT Specialist teams & the ENT Clinical Nurse Specialist.

More information about tracheostomies can be found here (for Healthcare Providers) and here (for Patients). A Tracheostomy Care Handbook (produced by Portex) can be found here. The UK National Tracheostomy Safety Project for clinicians can also be found here.

Wellington Tracheostomy Multidisciplinary Team

The Wellington TRAMS team have developed a standardised assessment form for reviewing ward patients.

Please select the image for a readable version or download a PDF copy for printing below.

TRAMS sticker

If you would like more information regarding the activity of Wellington TRAMS or are an ICU professional considering introducing such a team into your hospital, please contact Tom Andrews (CNS, Wellington ICU) for more information.

This page was last updated on Thursday, 08 January 2015 11:47:57

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