A59-04 Utilization and Effect of a Tracheostomy Navigator Role and Expanded Discharge Standardization Protocol for Pediatric Patients Requiring Tracheostomy and Chronic Mechanical Ventilation

Abstract Rationale The number of children requiring tracheostomy and/or invasive home mechanical ventilation (iHMV) has grown substantially driven by advancements in neonatal and pediatric critical care, improved technology, and evolving family preferences. Caring for children with medical complexity is challenging for families given risk and complexity. Mortality for children with tracheostomy remains high, ranging from 10-25%, primarily reflecting etiologic morbidity. Cohort studies suggest greater than 10% of tracheostomy deaths are related to equipment emergencies and may be preventable with trained caregivers. Standardized discharge processes reduce hospital length of stay (LOS) and post-discharge mortality. Following sentinel events, our institution implemented updated post-discharge training criteria and introduced the Navigator role, a dedicated Respiratory Therapist centralizing caregiver training and unifying discharge care. Evidence suggests discharge curricula and Navigator have been associated with reduced LOS, but their impact on other post-discharge outcomes remains understudied. Methods We conducted a single-center retrospective cohort study of pediatric patients undergoing tracheostomy at Brenner Children’s Hospital from October 2018 through October 2025. Demographic, clinical, and follow-up data were collected. The primary outcome was a composite of unanticipated death or serious adverse events. Secondary outcomes included post-tracheostomy LOS, 30-day readmission, and 30-day Emergency Department (ED) visits. ED visits unrelated to tracheostomy were excluded. Categorical data were analyzed using Pearson’s Chi-square test, and continuous data were compared with two-sample t-tests. Results Ninety (90) children underwent tracheostomy, with 52 prior to and 38 following implementation of the Navigator and standardized discharge pathway. Unplanned mortality or serious adverse events decreased from 11.5% to 5.3% This change did not reach statistical significance but remained significantly lower than nationally reported mortality rates (p 0.05). Post-tracheostomy LOS was unchanged (86±70 vs. 102±74 days, p = 0.269). 30-day readmission declined from 23% to 3% (p 0.01), and 30-day ED visits decreased from 15% to 0% (p = 0.01). Conclusions Implementation of a standardized discharge curriculum with a unified Navigator role was associated with trends toward reduced mortality, readmissions, and post-discharge ED utilization. LOS was not significantly affected, though early outliers with truncated post-tracheostomy hospital courses likely influenced results. Pediatric tracheostomy and home ventilation remains a challenging decision for caregivers due to associated risks and complexity. Consolidating caregiver training through a Navigator supports families in preparing for life after hospitalization and may improve post-discharge outcomes. This abstract is funded by: None