A standardized, closed‐loop system for monitoring pediatric tracheostomy‐related adverse events

McKeon, Mallory; Munhall, Daphne; Walsh, Brian K; Nuss, Roger C.; Rahbar, Reza; Volk, Mark S.; Watters, Karen

doi:10.1002/lary.27251

Cited by 8 publications

(11 citation statements)

References 9 publications

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“…Standardized monitoring and reporting of tracheostomy‐related airway complications are challenging within hospital systems 23 and even more limited in outpatient settings. A multicenter observational study of TDC in Spain found 50% of patients with a tracheostomy‐related death died at home from severe obstruction of the cannula and failure of resuscitation measures 24 .…”

Section: Discussionmentioning

confidence: 99%

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

Ong

Liu

Elder

et al. 2020

Otolaryngol.--head neck surg.

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Objective To describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy-related mortality in outpatient tracheostomy-dependent children (TDC). Methods An interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community-based nurses on TDC-focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic. The primary outcome was annual unanticipated mortality after hospital discharge from tracheostomy placement before and after the initiative. Results In the 5 years before and after the initiative, 131 children and 155 children underwent tracheostomy placement, respectively. At the end of the study period, the institution sustained Trach Safe practices: (1) surveillance bronchoscopies increased from 104 to 429 bronchoscopies, (2) the course trained 209 community-based nurses, and (3) the survey was used in 488 home ventilator clinic visits to identify near-miss airway events. Prior to the initiative, 9 deaths were unanticipated. After Trach Safe implementation, 1 death was unanticipated. Control chart analysis demonstrates significant special-cause variation in reduced unanticipated mortality. Discussion We describe a system shift in reduced unanticipated mortality for TDC through 3 major practice changes of the Trach Safe Initiative. Implication for Practice Death in a child with a tracheostomy tube at home may represent modifiable tracheostomy-related airway events. Using Trach Safe practices, we address multiple facets to improve safety of TDC out of the hospital.

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Section: Discussionmentioning

confidence: 99%

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

Ong

Liu

Elder

et al. 2020

Otolaryngol.--head neck surg.

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“…More than half are less than a year old when the tracheostomy is placed. The need for long-term mechanical ventilation in infants and children often stems from respiratory problems associated with prematurity, hypotonia, bronchopulmonary dysplasia, neurological impairment, and congenital heart and lung disease (Liu et al, 2014;McKeon et al, 2018;Sakai et al, 2019;Watters, 2017). The large set of skills that lay caregivers must acquire to care for the child at home is daunting.…”

Section: Literature Reviewmentioning

confidence: 99%

“…HMV through a tracheostomy requires a complex set of skills that need to be mastered by caregivers. Children requiring a tracheostomy often have multiple chronic and complex comorbid conditions (Liu et al, 2014;McKeon et al, 2018). Sterni et al (2016) suggested that among children in the United States with special healthcare needs, few have more challenges than those requiring chronic home invasive ventilation.…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Websites Offering Caregiver Education for Tracheostomy and Home Mechanical Ventilation

Misra

Oermann

Teague

et al. 2021

Journal of Pediatric Nursing

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Background: Parental and familial caregivers of a child with a tracheostomy, and possibly home mechanical ventilation (HMV), face the overwhelming task of learning to medically care for their child prior to discharge. Caregivers may cope by seeking health information on the Internet. This is concerning because information found during an Internet search may not be accurate, comprehensive, or up to date. The purpose of this project was to evaluate the quality and content of websites offering information about tracheostomies and HMV using a valid assessment tool. Methods: A total of 46 websites were identified for evaluation using the DISCERN instrument for quality and reliability, and the Flesch Reading Ease (FRE) and Flesh-Kincaid (FK) grade level instruments for readability. Accuracy of content was determined by expert opinion. Findings: Few of the websites met the recommended quality and/or readability levels. The websites recommended had a range of DISCERN scores 21-40, adjusted FRE 61-89.1, and adjusted FK 3.4-6.9. Many of the highest quality websites had a readability level at high school or college levels. Discussion: The quality and readability of websites offering caregiver education for tracheostomy and HMV are not at a level suitable for caregivers. There was often a mismatch between DISCERN quality and readability. Many high-quality websites would not be easily read and understood by the general lay population. Application to practice: DISCERN alone is not sufficient to determine whether a website should be recommended. One should consider reliability, quality, and readability when developing patient education materials, including those on the Internet.

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“…All TRAEs were standardized per 1000 inpatient tracheostomy-days, which was calculated automatically by a hospital-generated list each month. 4 The standardized frequency of events was maintained in a running chart to track trends. The TRAEs were also categorized by event type to emphasize the most commonly occurring events and highlight areas for improvement.…”

Section: Standardized Trae Reporting Systemmentioning

confidence: 99%

“…Multidisciplinary coordinated care has been shown to effectively reduce the occurrence of adverse events in patients with a tracheostomy. 4 The following 5 key drivers of tracheostomy care have been established to help implement quality-driven care: standardization of care, broad staff education, patient and family involvement, monitoring of outcomes, and multidisciplinary collaboration. 5 In 2015, Boston Children's Hospital (BCH), Boston, Massachusetts, created a multidisciplinary tracheostomy team (MDT) to implement these key drivers.…”

mentioning

confidence: 99%

Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

McKeon

Kohn

Munhall

et al. 2019

JAMA Otolaryngol Head Neck Surg

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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...

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A standardized, closed‐loop system for monitoring pediatric tracheostomy‐related adverse events

Abstract: 4. Laryngoscope, 128:2419-2424, 2018.

Cited by 8 publications

References 9 publications

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

An Evaluation of Websites Offering Caregiver Education for Tracheostomy and Home Mechanical Ventilation

Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

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