The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

Area of Science:

• Pediatric critical care
• Quality improvement in healthcare
• Patient safety

Background:

• Children dependent on tracheostomy (TDC) face risks of unanticipated mortality.
• Effective safety protocols are crucial for managing TDC outside hospital settings.

Purpose of the Study:

• To describe the Trach Safe Initiative.
• To assess its impact on unanticipated tracheostomy-related mortality in TDC.

Main Methods:

• An interdisciplinary team, including parents, designed the initiative using quality improvement methods.
• Key changes included surveillance airway endoscopy, emergency airway management education for nurses, and routine clinic assessments.
• The primary outcome measured was annual unanticipated mortality before and after the initiative.

Main Results:

• The initiative saw increased surveillance bronchoscopies (104 to 429) and trained 209 community nurses.
• Routine assessments identified near-miss airway events in 488 clinic visits.
• Unanticipated deaths decreased from 9 to 1, with significant reduction shown by control chart analysis.

Conclusions:

• The Trach Safe Initiative represents a system shift that reduced unanticipated mortality in TDC.
• Implementing these practice changes improves the safety of TDC at home by addressing modifiable airway events.