Standardizing Care and Parental Training to Improve Training Duration, Referral Frequency, and Length of Stay: Our Quality Improvement Project Experience

Tolomeo, Concettina; Major, Nili E.; Szondy, Mary V; Bazzy‐Asaad, Alia

doi:10.1016/j.pedn.2016.10.004

Cited by 14 publications

(20 citation statements)

References 15 publications

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“…32,50 Tracheostomy caregiver training is inconsistent and with variable outcomes. 16,17,21,22,50,51 Although most caregivers interviewed felt prepared to go home following in-hospital training, the transition home was difficult. While specific caregiver preferences of tracheostomy training varied (eg, utility of using a doll), many caregivers desired tailored training and additional training for emergency situations.…”

Section: Discussionmentioning

confidence: 99%

“…13-15 This model promotes continuous, comprehensive, family-centered, accessible, coordinated, compassionate, and culturally effective care. 14-18 Mutual trust and responsibility exist between families/clinical providers, and a broad supportive network exists to effectively communicate and coordinate care. 18,19 While the principles of the medical home are described in several models, 11,13,15,20 protocols for meeting caregiver needs and for CWT care transitions are lacking.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…19 Despite needs for adequate training of caregivers and home nurses, education of tracheostomy care is not standardized nor critically evaluated for effectiveness. 16,17,20 This is likely attributed to the paucity of literature and variation in resources at children's hospitals/pediatric rehabilitation facilities affecting health care outcomes across institutions. 20,21 The combination of significant medical complexity, potential for life-threatening complications, 22 and lack of standardization of care transitions and training for caregivers/home nursing agencies place CWT at high risk for morbidity and mortality fostering dependence on crisis-driven care.…”

mentioning

confidence: 99%

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Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Mai

Davis

Hamilton

et al. 2020

Clin Pediatr (Phila)

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This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Mai

Davis

Hamilton

et al. 2020

Clin Pediatr (Phila)

View full text Add to dashboard Cite

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“…A formal need assessment of caregivers who received tracheostomy education at our institution found more frequent hands-on practice and improved consistency of instruction were needed. Other institutions have noted similar challenges with their tracheostomy education programs 7,15–17 . To address these identified needs, we developed 2 simulation-based curricula, one for caregivers and one for bedside staff.…”

mentioning

confidence: 99%

Assessing Competence With a Task Trainer

et al. 2021

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IntroductionThe purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer.MethodsThree tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members.ResultsIntraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%.ConclusionsWe developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.

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Mortality Among Children with a Tracheostomy

et al. 2022

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Objectives To characterize the cause of death among children with a tracheostomy. Study Design Prospective cohort. Methods All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. Results A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy‐related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59–10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24–4.48) correlated with time to death on Cox proportional hazard modeling. Conclusions Nearly one‐third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy‐related complication, which represents a meaningful target for quality improvement initiatives. Level of Evidence 3 Laryngoscope, 133:403–409, 2023

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Standardizing Care and Parental Training to Improve Training Duration, Referral Frequency, and Length of Stay: Our Quality Improvement Project Experience

Cited by 14 publications

References 15 publications

Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Assessing Competence With a Task Trainer

Mortality Among Children with a Tracheostomy

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