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Standardizing Care and Parental Training to Improve Training Duration, Referral Frequency, and Length of Stay: Our
Concettina Tina Tolomeo1, Nili E Major2, Mary V Szondy3
1Yale University School of Medicine, Department of Pediatrics, Section of Respiratory Medicine, 333 Cedar Street, LMP 3094, New Haven, CT 06520-8064, United States.
Insights
A new care model and standardized training for parents of infants with tracheostomy tubes reduced training time and hospital stays. This quality improvement initiative also increased developmental assessments for these technology-dependent children.
Area of Science:
- Pediatric Respiratory Care
- Quality Improvement Science
- Healthcare Education
Background:
- Inconsistent patient care and parent education were identified in a Pediatric Respiratory Care Unit for technology-dependent infants with tracheostomy tubes.
- A six-bed unit specializing in technology-dependent infants and children with tracheostomy tubes faced challenges in standardizing care and training.
Purpose of the Study:
- To standardize care and skills proficiency training for parents of infants with tracheostomy tubes before home discharge.
- To evaluate if a standardized approach could decrease parental training time and length of stay, and increase developmental interventions.
Main Methods:
- A multidisciplinary quality improvement project was initiated.
- A convenience sample of infants with tracheostomy tubes admitted to the unit were included.
- Descriptive statistics were used to analyze the results of the implemented changes.
Main Results:
- The time required for parents to achieve proficiency in infant care decreased.
- The length of hospital stay for these infants was reduced.
- Referrals for developmental assessment for infants with tracheostomy tubes increased.
Conclusions:
- Standardized care and training protocols can lead to sustained improvements in patient care.
- This quality improvement approach has implications for addressing deficiencies in pediatric respiratory care.
- The study demonstrates the effectiveness of a new model of care in a specialized pediatric unit.
Objectives:
At our institution, there is a six bed Pediatric Respiratory Care Unit for technology dependent infants and children with a tracheostomy tube. A lack of consistency in patient care and parent/guardian education prompted our group to critically evaluate the services we provided by revisiting our teaching protocol and instituting a new model of care in the Unit. The aims of this quality improvement (QI) project were to standardize care and skills proficiency training to parents of infants with a tracheostomy tube in preparation for discharge to home.
Methods:
After conducting a current state survey of key unit stakeholders, we initiated a multidisciplinary, QI project to answer the question: 'could a standardized approach to care and training lead to a decrease in parental/guardian training time, a decrease in length of stay, and/or an increase in developmental interventions for infants with tracheostomy tubes'? A convenience sample of infants with a tracheostomy tube admitted to the Pediatric Respiratory Care Unit were included in the study. Descriptive statistics were used to analyze the results.
Results:
Through this QI approach, we were able to decrease the time required by parents to achieve proficiency in the care of a technology dependent infant, the length of stay for these infants, and increase referral of the infants for developmental assessment.
Conclusions:
These outcomes have implications for how to approach deficiencies in patient care and make changes that lead to sustained improvements.
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