Risk factors for return visits in children discharged with tracheostomy

Pettitt-Schieber, Brian; Mahendran, Geetha; Tey, Ching Siong; Prickett, Kara K.

doi:10.1016/j.ijporl.2021.110860

Cited by 7 publications

(22 citation statements)

References 43 publications

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“…32 Children in the first 6 months after discharge with tracheostomy placement had a mean of 4.3 unplanned readmissions in one series with 21% requiring at least five visits. 4 A retrospective study of 100 children under 2 years old determined that admissions can be frequent in the first 1.5 years after placement. 10 While returns to the hospital are common early after discharge, the data shown here suggests that utilization can remain high with nearly half of these children necessitating frequent hospital visits during the first 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with other studies identifying high rates of respiratory infections among pediatric tracheostomy readmissions. 4,10,15,32 Viral or bacterial pneumonia is often the etiology when children with a tracheostomy present to the ED with respiratory problems. 33 Clinicians must recognize this source of morbidity especially since tracheostomy placement for respiratory failure secondary to bronchopulmonary dysplasia has increased over the last several decades.…”

Section: Discussionmentioning

confidence: 99%

“…36 The most common issues associated with gastrostomy tubes include leaking, mild clogging, and granulation tissue. 4 The rate of gastrostomy tube placement among children with a tracheostomy is high with more than two-thirds obtaining them for enteral feeding. 37 This contributes to a meaningful source of resource utilization for these children.…”

Section: Discussionmentioning

confidence: 99%

“…Rates of tracheostomy problems leading to readmissions reach 35% in prior series. 4,10,15,38 Accidental decannulations, tracheostomy bleeding, and stoma infections are among some of the frequent reasons children with a tracheostomy may require attention. Both feeding tubes and tracheostomy tubes can prompt unplanned revisits.…”

Section: Discussionmentioning

confidence: 99%

“…2 This results in a group that is particularly vulnerable to complications and high resource utilization after tracheostomy. 4,5 The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) recognized the need to define patient factors that influence the frequency of emergency department (ED) visits and hospital readmissions after tracheostomy among all age groups. 6 In otolaryngology, a range of patient-specific factors and surgical complications have been associated with increased hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

et al. 2022

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Objective: To determine factors associated with frequent emergency department (ED) visits and hospitalizations after pediatric tracheostomy.Methods: A prospective cohort of children (<18 years) with a tracheostomy placed at a tertiary children's hospital between 2015 and 2019 were followed for 24 months after index discharge. ED visits and hospitalizations were recorded to identify risk factors for frequent utilization (≥4 visits).Results: A total of 239 children required 1285 total visits to the ED or hospital after index discharge with 112 children (47%) having ≥4 visits. Respiratory-related illness was the most common reason (N = 699, 54%) followed by gastrostomy tube issues (N = 119, 9.3%). Frequent utilization was associated with Black race (

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

et al. 2022

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Pediatric Tracheostomy Education Program Structures, Barriers, and Support: A Nationwide Survey of Children's Hospitals

Acorda,

Van Orne

2024

Otolaryngol.--head neck surg.

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ObjectiveSafe discharge for children with tracheostomies requires caregivers to be competent in tracheostomy management, including emergency interventions. Inpatient pediatric units are tasked with preparing families for discharge, yet variations exist in the standards of tracheostomy education across institutions. To address this gap, we aimed to describe the inpatient tracheostomy education programs in children's hospitals across the United States.Study DesignThis is a cross‐sectional study conducted between May and July 2022.SettingWe distributed an online survey to a purposeful sample of representatives from participating children's hospitals.MethodsThe 42‐item survey evaluated various aspects of tracheostomy education, including teaching strategies, timing of education, operational support, and overall program structure. Descriptive statistics were generated, and researchers reviewed open‐ended items to identify themes.ResultsThirty‐seven institutions participated, 26 of which were free‐standing children's hospitals. All programs surveyed conducted bedside checkoffs, required a rooming‐in period, and provided tracheostomy cardiopulmonary resuscitation and low‐fidelity simulation for emergency teaching. Programs varied in the order of education and the type of support received. Many programs lacked a postdischarge follow‐up structure and the majority evaluated program effectiveness with readmission rates. Lack of private‐duty nursing was the primary barrier to discharge, followed by family availability and reluctance to participate in education.ConclusionThe program structure and support variations suggest that more investigation is needed in discharge education and postdischarge follow‐up for children with tracheostomies. A national guideline for tracheostomy education and identification of standardized quality metrics for program evaluation would benefit current and emerging programs.

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Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

Zhang,

Liu,

Narayanan

et al. 2024

OTO Open

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ObjectiveThis study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.Study DesignProspective analysis.SettingAcademic children's hospital.MethodsCosts associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges‐to‐costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders.ResultsA total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow‐up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions.ConclusionPediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.

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Risk factors for return visits in children discharged with tracheostomy

Cited by 7 publications

References 43 publications

Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

Pediatric Tracheostomy Education Program Structures, Barriers, and Support: A Nationwide Survey of Children's Hospitals

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

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