The Impact of Post-Discharge Call Interview to Improve the Screening of Post-Intubation Tracheal Stenosis: An Experimental Study

Abstract

Background: Tracheal stenosis is one of the worst complications of endotracheal intubation, but timely diagnosis can change its natural history. Management of these patients places a great burden on the health care system and the well-being of the patients and their families. Therefore, discharged intensive-care-unit (ICU) patients who underwent more than 24 hours of intubation should be actively followed-up 3 months after extubation and screened for post-intubation tracheal stenosis. The present study was aimed at assessing the impact of post-discharge follow-up call interviews on increasing successful screening for post-intubation tracheal stenosis. Objectives: To determine the effect of post-discharge call interviews on improving screening of post-intubation tracheal stenosis. Methods: This experimental study was conducted in Iran in September 2014. Using the simple randomization method, 140 patients who had undergone than 24 hours of endotracheal intubation and had received oral and written educational materials upon discharge from the ICU were equally assigned to an intervention and a control groups (received a call interview before or after the follow-up due date, respectively). The needed sample size was calculated to be 70 participants in each group (considering α = 5%, the statistical power of 90%, and effect size = 0.4). Results: There was a significant difference in follow-up rates at the due date between the intervention group (50.7%, 34of 67 participants) and the control group (17.5%, 11 of 63 participants) (OR = 4.871, 95% CI = 2.172 to 10.924, P < 0.0001). In the control group, the call interviews significantly increased the follow-up rate from 17.5% to 66.7 % (42 of 63 participants) (P < 0.0001), although follow-up occurred after the due date. The results of the logistic regression model showed that the patients who had attempted suicide completed follow-up more than those who had not (P = 0.017), that interviews with patients and their parents were more effect than interviews with others (P < 0.05), and that phone call interviews after the follow-up due date were more effective than those before the follow-up due date (OR = 2.653, 95%CI = 1.079 to 6.526, P = 0.034). Conclusions: We highly recommend making call interviews, along with distributing the oral and written educational materials, to increase the follow-up rate among discharged ICU patients.