Effectiveness of the AIIMS ICU Rehabilitation (AIR) intervention package facilitating supported discharge and family-led home-based care of chronically ill patients with a tracheostomy: a multicentric mixed methods study.

Tracheostomy, a procedure to create an opening in front of the trachea when performed on critically ill patients in intensive care units (ICUs) decreases the duration of mechanical ventilation, incidence of nosocomial infections and length of ICU stay. Its use early during (1)neuro-ICU stayis associated with improved chances of early rehabilitation and discharge due to decreased secondary insults and hospital acquired morbidity.(1) However when there is a lack of out-of-hospital state- sponsored or low cost rehabilitation facilities for these chronically ill bed ridden patients, timely discharge from the ICU and hospital becomes a challenge.  These patients need higher intensity care at home, including care of the tracheostomy and indwelling catheters, home ventilation, nasogastric feeding, physiotherapy and general nursing care. Fear, stigma and unpreparedness among family members and healthcare workers of caring for a patient with ‘a hole in the neck’ prolongs ICU and hospital stay, increasing the very morbidities the tracheostomy sought to avoid. Cost of care to patient family (carer) and the health care system increases as resources cannot be offered to more deserving acutely ill patients.

To address this gap, in Eastern India, we have developed, and pilot tested the AIIMS ICU Rehabilitation Intervention. The intervention with its components of counselling, hands-on training and education, facilitated discharge and post discharge support aims to implement family led home rehabilitation of chronically critically ill tracheostomy patients. This trial is to implement the intervention in three centres and evaluate the implementation process and effectiveness of the AIR intervention for family led home discharge of chronically critically ill post ICU patients.