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A Multidisciplinary Children's Airway Center: Impact on the Care of Patients With Tracheostomy
Kathleen A Abode1, Amelia F Drake2, Carlton J Zdanski2
1University of North Carolina Health Care System, Chapel Hill, North Carolina; and Division of Pulmonology, Department of Pediatrics, and jka@med.unc.edu.
Insights
A multidisciplinary Children's Airway Center improved care for children with tracheostomies by optimizing hospital discharge and reducing complications. This coordinated approach led to better communication and outcomes for pediatric patients requiring airway support.
Area of Science:
- Pediatric medicine
- Surgical specialties
- Healthcare management
Background:
- Children with complex airway issues often require care from multiple specialists.
- A multidisciplinary Children's Airway Center was established to coordinate care and improve outcomes.
- Specific focus areas for children with tracheostomies included optimizing discharge, enhancing communication, and preventing complications.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary Children's Airway Center in managing pediatric tracheostomies.
- To assess improvements in hospital discharge, provider-caregiver communication, and complication rates.
- To determine if a coordinated, multidisciplinary approach yields measurable positive outcomes.
Main Methods:
- The study included children up to 21 years old with tracheostomies.
- A multidisciplinary team comprising pediatric pulmonology, otolaryngology, and gastroenterology providers was involved.
- Improvement initiatives included enhanced education, weekly care conferences, consensus guidelines, personalized schedules, and standardized examination intervals.
Main Results:
- The center evaluated a median of 172 new patients annually, with 123 having tracheostomies.
- Median hospitalization duration for infants (<1 year) with new tracheostomies decreased from 37 to 26 days.
- Adherence to consensus protocols increased successful decannulation rates from 68% to 86%.
Conclusions:
- The Children's Airway Center successfully optimized hospitalization, communication, and complication avoidance for pediatric tracheostomy patients.
- A multidisciplinary team approach in a specialized center leads to significant improvements in patient outcomes.
- Sustained improvements demonstrate the value of coordinated, specialized care for complex pediatric airway conditions.
Background:
Children with complex airway problems see multiple specialists. To improve outcomes and coordinate care, we developed a multidisciplinary Children's Airway Center. For children with tracheostomies, aspects of care targeted for improvement included optimizing initial hospital discharge, promoting effective communication between providers and caregivers, and avoiding tracheostomy complications.
Methods:
The population includes children up to 21 years old with tracheostomies. The airway center team includes providers from pediatric pulmonology, pediatric otolaryngology/head and neck surgery, and pediatric gastroenterology. Improvement initiatives included enhanced educational strategies, weekly care conferences, institutional consensus guidelines and care plans, personalized clinic schedules, and standardized intervals between airway examinations. A patient database allowed for tracking outcomes over time.
Results:
We initially identified 173 airway center patients including 123 with tracheostomies. The median number of new patients evaluated by the center team each year was 172. Median hospitalization after tracheostomy decreased from 37 days to 26 days for new tracheostomy patients <1 year old discharged from the hospital. A median of 24 care plans was evaluated at weekly conferences. Consensus protocol adherence increased likelihood of successful decannulation from 68% to 86% of attempts. The median interval of 8 months between airway examinations aligned with published recommendations.
Conclusions:
For children with tracheostomies, our Children's Airway Center met and sustained goals of optimizing hospitalization, promoting communication, and avoiding tracheostomy complications by initiating targeted improvements in a multidisciplinary team setting. A multidisciplinary approach to management of these patients can yield measurable improvements in important outcomes.
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