placement in children is increasing, and these children continue to have high incidences of morbidity and mortality. A multidisciplinary tracheostomy program may help improve the quality of care received by these patients.OBJECTIVE To determine whether implementation of a multidisciplinary tracheostomy program can improve the care of children who received a tracheostomy through reduction in tracheostomy-related adverse events (TRAEs), improved tracheostomy education, and caregiver preparedness. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study was conducted from January 2015 to June 2018 at a pediatric tertiary referral center in Boston, Massachusetts. The participants included 700 children who had received a tracheostomy, most of whom were aged birth to 18 years, but some patients with congenital disorders were much older.EXPOSURES Institution of a multidisciplinary tracheostomy team (MDT) whose activities included conducting staff meetings, organizing outpatient clinics, conducting inpatient tracheostomy ward rounds, and conducting inpatient tracheostomy rounds at a local rehabilitation hospital. Quality improvement initiatives included monitoring standardized TRAEs and distributing standardized tracheostomy "go-bags."MAIN OUTCOMES AND MEASURES Reduction of TRAEs and improved caregiver preparedness through distribution of tracheostomy go-bags were assessed following the establishment of a multidisciplinary tracheostomy program. RESULTSIn total, 700 children who had received a tracheostomy during the study period were actively followed up by the MDT. Of these children, 378 (54.0%) were males and 322 (46.0%) were females; mean (SD) age was 4.1 (6.1) years. More than 60 new pediatric tracheostomies were performed annually at the referral center. Reported TRAEs were reduced by 43.0% from the first to the third year after the implementation of a standardized, closed-loop monitoring system (from a mean [SD] of 6.1 [5.2] TRAEs per 1000 inpatient tracheostomy-days in 2015 to a mean [SD] of 4.0 [2.5] in 2018). The most common TRAE was unplanned decannulation, which occurred 64 times during the study period. On average, 10 patients were seen in each monthly multidisciplinary tracheostomy clinic. Clinic interventions included continuing care (146 [52.5%]), communication enhancement (67 [23.6%]), plans for decannulation (52 [18.6%]), and referrals for comorbidities (13 [4.6%]). Approximately 19 inpatients were seen during biweekly rounds and 8 during monthly rounds at a local rehabilitation hospital. A total of 297 patients received standardized tracheostomy go-bags, and more than 70 positive bag checks were performed in the monthly MDT clinics. A positive bag check refers to the incidence when a family is given a go-bag and also uses it. In contrast, a negative bag check refers to when a family is given a go-bag but neither brings it to the clinic nor acknowledges that they use it.CONCLUSIONS AND RELEVANCE This study's findings suggest that a multidisciplinary tracheostomy program may be a powerful tool for enha...

Objectives/Hypothesis To determine demographic factors associated with failure to complete ordered polysomnograms (PSGs) in pediatric patients with sleep‐disordered breathing (SDB). Study Design Retrospective case series. Methods This study was conducted at an urban safety‐net hospital and included 829 patients with SDB, ages 0 to 18 years, for whom PSGs were ordered during a 1‐year time period. Factors including age, race, language, and insurance status were reported for each patient. The data were reviewed by univariate and multivariate analyses to determine factors associated with failure to complete the PSGs. Results Of 829 patients, 200 (24%) failed to complete the PSGs. By univariate analysis, age was the only significant factor affecting completion (P < .01), with toddlers having the highest rate of completion (81%) and teenagers the lowest (68%). Primary language and insurance type were not significantly associated with completion rate. Hispanics were more likely than non‐Hispanic whites to complete the PSGs (81% vs. 70%), but this did not achieve statistical significance. By multivariate analysis, the teenage group remained significantly less likely to complete sleep study than toddlers (P = .04). There was again no statistically significant difference for race by multivariate analysis. Conclusions Among pediatric patients with SDB, age is a significant factor affecting completion of PSGs. Racial minorities and non–English‐speaking patients were not less likely to complete PSGs. Other demographic factors do not appear to be associated with completion of PSGs. Level of Evidence 4 Laryngoscope, 130:E258–E262, 2020

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