Background: Pediatric patients who experience severe acute illness either at birth or secondary to acute or chronic disease can experience profound respiratory failure. Tracheostomy tubes provide a secure airway, assistance with ventilatory support and route to safe discharge home for recovering or chronically ill patients. Methods: A needs assessment was performed at our tertiary care center involving all stakeholders. Several areas of improvement were quickly identified: improve communication with caregivers regarding discharge readiness, establish clearly defined roles for staff, and improve hands-on skills assessment with simulation. A roadmap was created at each patient’s bedside to allow for caregivers and team members to track the progress towards their child’s discharge. A revised CPR and new simulation curriculum were created to assess caregiver skill. A pre and post simulation surveys assessed caregiver comfort via five-point Likert scale. A preintervention population from 2019 to 2020 was used for outcome comparison. Results: Ten patients were enrolled and completed our updated education pathway including patient discharge roadmap and simulation scenarios between 2021 to 2022. Outcomes were compared with 7 patients who received new tracheostomies from 2019 to 2020 prior to intervention. Education documentation was completed for 50% of caregiver preintervention and 80% post. Readmission for respiratory complaint involving tracheostomy prior to intervention within three months of discharge was 43%, three patients with readmission and one death. Post intervention readmission for respiratory complaint was 30% with no deaths. Pre and post simulation surveys demonstrated 60% improvement in caregiver comfort for bedside skills following simulation, particularly tracheostomy tube replacement, rescue breathing and cardiopulmonary resuscitation. Conclusions: Pediatric patients receiving tracheostomies are a medically fragile population with readmission or tracheostomy related complications and complaints accounting for 10% of their hospital evaluations and admissions. Incorporation of our tracheostomy education checklist into our electronic medical record improved documentation compliance. The addition of simulation education improved caregiver comfort regarding bedside skills particularly emergency skills. Overall, our interventions were associated with reduced readmission for respiratory complaints regarding tracheostomies.Table 1. Patient DemographicsAge, M, median (IQR)10.5 (2.75, 27.5) Gender, nMale7 Female3 Race, nCaucasian2 Hispanic7 African American1 Location, nNICU2 PICU7 PCICU1 InsuranceMedicaid9 Private1 Surgery to Discharge, D, median (IQR)42 (31, 98) NICU65 (35, 95) PICU36 (31, 73) PCICU120 M, months; IQR, interquartile range; NICU, neonatal ICU; PICU, pediatric ICU; PCICU, pediatric cardiac ICU; D, days
Silva et al. (Sun,) studied this question.