Quantifying the benefits from a care coordination program for tracheostomy placement in neonates

Caloway, Christen; Yamasaki, Alisa; Callans, Kevin; Shah, Meet; Kaplan, Robert S.; Hartnick, Christopher J.

doi:10.1016/j.ijporl.2020.110025

Cited by 7 publications

(13 citation statements)

References 15 publications

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“…Hartnick et al 10 studied a group of neonates who underwent tracheostomy before and after implementation of a tracheostomy team. 14 They reduced the length of stay, estimated a potential cost savings, and showed quality-of-life improvement after implementation. Notably, these studies were limited to a small sample of children electively admitted for tracheostomy, and total costs of the hospital stays were unexplored.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the potential benefits of a multidisciplinary tracheostomy program, objective outcome assessments remain limited. Hartnick et al 10 studied a group of neonates who underwent tracheostomy before and after implementation of a tracheostomy team 14 . They reduced the length of stay, estimated a potential cost savings, and showed quality‐of‐life improvement after implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Despite evidence that dedicated teams and standardized processes can reduce tracheostomy utilization and costs in adults, 12 there have been very few studies to examine this strategy in pediatric patients. 10,14,15 Economic investigations that include sensitivity analyses have also been limited. Demonstrating that a multidisciplinary tracheostomy team (MDT) and standardized processes can improve utilization and costs would be beneficial to health care systems, providers, and families who care for these complex children.…”

mentioning

confidence: 99%

“…Pediatric initiatives typically involve the latter two since early tracheostomy is not consistently performed in young children. Despite evidence that dedicated teams and standardized processes can reduce tracheostomy utilization and costs in adults, 12 there have been very few studies to examine this strategy in pediatric patients 10,14,15 . Economic investigations that include sensitivity analyses have also been limited.…”

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confidence: 99%

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Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Chorney

Brown²,

Brooks³

et al. 2021

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Objectives To analyze a multidisciplinary tracheostomy team’s effect on length of stay and cost. Methods An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and caregiver education. Process measures included time to first education, speech-language pathology consultation rates, and pretracheostomy consultations. Outcome measures focused on the total length of stay, 30-day revisit rates after discharge, accidental decannulation rate, and standardized cost. Regression analysis was used to predict the program’s effect on length of stay and total cost. Results In total, 239 children met inclusion. The mean time to first education class was reduced from 13.7 to 1.9 days ( P < .001). The speech-language pathology consultation rate increased from 68% to 95% ( P < .001), and the presurgical consultation rate with the tracheostomy team increased from 14% to 93% ( P < .001). The length of stay decreased from 133 to 96 days ( P = .006). Total costs were lower for short admissions but higher for prolonged admissions. Revisits within 30 days remained stable over time (18%). Discussion Establishing a multidisciplinary tracheostomy team results in improvements in quality metrics when caring for children with tracheostomies. Controlling for associated factors showed the mean length of stay decreased significantly in the first full year of program implementation. Cost analysis estimated significant reductions for tracheostomy patients spending less time in the hospital. Implications for Practice A airway management program can positively affect tracheostomy processes and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Chorney

Brown²,

Brooks³

et al. 2021

OTO Open

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“…Another key role performed by the LTMV nurse is to provide care‐giver education, act as a liaison point for community health care workers, and oversee the multiple other components that contribute to the successful and sustainable provision of home LTMV. A dedicated team, as well as a focal point in the form of a Tracheostomy Care Manager/Nurse, has been shown to result in significant time‐driven activity‐based cost savings of 61% in the discharge planning phase of neonatal tracheostomy patients 33 …”

Section: Discussionmentioning

confidence: 99%

Pediatric invasive long‐term ventilation—A 10‐year review

Walsh

Furlong

Nally

et al. 2021

Pediatric Pulmonology

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Introduction The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long‐term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10‐year period were reviewed to see if our demographics and outcomes are in line with global trends. Methods Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009–2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. Results Forty‐six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10‐year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year‐on‐year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. Conclusion Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.

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Long‐term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy (ISPAT) project

Bilgin,

Unal,

Yanaz

et al. 2023

Pediatric Pulmonology

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Background and ObjectivesChildren with tracheostomies are at increased risk of tracheostomy‐related complications and require extra care. Standardized training programs for caregivers can improve tracheostomy care and reduce complications. In this study, we compared caregiver knowledge and skill scores after a standardized theoretical and practical training program on tracheostomy care (IStanbul PAediatric Tracheostomy (ISPAT) project) immediately and 1 year post‐training and evaluated how this training affected the children's clinical outcomes.Materials and MethodsWe included 32 caregivers (31 children) who had received standardized training a year ago and administered the same theoretical and practical tests 1 year after training completion. We recorded tracheostomy‐related complications and the number and reasons for admission to the healthcare centers. All data just before the training and 1 year after training completion were compared.ResultsAfter 1 year of training completion, the median number of correct answers on the theoretical test increased to 16.5 from 12 at pretest (p < 0.001). Compared with pretest, at 1‐year post‐training practical skills assessment scores, including cannula exchange and aspiration, were significantly higher (both p < 0.001) and mucus plug, bleeding, and stoma infection reduced significantly (p = 0.002, 0.022, and 0.004, respectively). Hands‐on‐training scores were better than pretest but declined slightly at 1 year compared to testing immediately after training. Emergency admission decreased from 64.5% to 32.3% (p = 0.013). Hospitalization decreased from 61.3% to 35.5% (p = 0.039).ConclusionOur findings indicate that caregiver training can lead to a persistent increase in knowledge and skill for as long as 1 year, as well as improvements in several measurable outcomes, although a slight decrease in scores warrants annual repetitions of the training program.

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Quantifying the benefits from a care coordination program for tracheostomy placement in neonates

Cited by 7 publications

References 15 publications

Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Pediatric invasive long‐term ventilation—A 10‐year review

Long‐term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy (ISPAT) project

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