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Published on: January 17, 2011
Effects of dedicated inpatient rounds on tracheostomy care in children
Zialesi W Adissem1, Jordan I Gewirtz2, Isaac Kistler3
1Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Weekly multidisciplinary tracheostomy team (MDT) rounds improved care for young children with tracheostomies. These rounds increased surveillance and facilitated timely, lower-risk interventions, enhancing patient outcomes.
Area of Science:
- Pediatric Otolaryngology
- Healthcare Management
- Patient Safety
Background:
- Tracheostomies in children under two years old require specialized, ongoing care.
- Effective multidisciplinary team coordination is crucial for managing complex pediatric cases.
- Routine surveillance and timely interventions can prevent complications in young tracheostomy patients.
Purpose of the Study:
- To describe the implementation of weekly multidisciplinary tracheostomy team (MDT) rounds.
- To evaluate the impact of MDT rounds on surveillance and interventions for pediatric tracheostomy patients.
- To assess changes in care for children under two years with tracheostomies post-MDT implementation.
Main Methods:
- Retrospective study design at a tertiary referral children's hospital.
- Inclusion of all inpatient encounters for patients under two with existing tracheostomies.
- Comparison of admissions one year before and after the initiation of weekly MDT rounds.
Main Results:
- MDT rounds significantly increased otolaryngology encounters during admissions (OR: 2.38).
- Stomal concerns decreased post-implementation (OR: 0.13), indicating improved monitoring.
- Surveillance procedures like direct laryngoscopy and bronchoscopy increased (OR: 5.58), alongside other recommended interventions (OR: 9.66).
Conclusions:
- Weekly MDT rounds enhanced the care of pediatric patients with tracheostomies.
- The structured approach led to increased surveillance and access to lower-acuity interventions.
- Dedicated MDT ward rounds improved overall management and outcomes for this vulnerable population.
Objective:
To describe our institution's weekly multidisciplinary tracheostomy team (MDT) rounds and assess their effect on increasing routine surveillance and low acuity interventions for patients with tracheostomies under two years of age.
Study Design:
Retrospective.
Setting:
Tertiary referral children's hospital.
Methods:
All inpatient encounters below age two with an existing tracheostomy were included. Patients receiving tracheostomies during their admission were excluded. All comparisons were made between admissions one year before and after implementation of tracheostomy team rounds.
Results:
One hundred thirty admissions (43 unique patients, 51 % female) were found, of which 56 occurred one year before the start of weekly rounds. Twenty-three percent of admissions were related to the patient's tracheostomy. Rounds increased otolaryngology encounters during an admission (OR: 2.38, 95 % CI [1.16, 4.89], p = 0.018). Stomal concerns noted during admission decreased with the implementation of rounds (OR: 0.13, 95 % CI [0.03, 0.66], p = 0.014). The number of surveillance direct laryngoscopy and bronchoscopy (DLB) preformed as recommend from MDT rounds increased after the implementation of rounds (OR 5.58, 95 % CI [2.09, 14.9], p < 0.001) as did other interventions recommended during rounds but not done immediately at bedside (OR 9.66, 95 % CI [3.40, 27.5], p < 0.001).
Conclusion:
Aspects of care for children less than two years of age with tracheostomies were improved after implementation of the multidisciplinary tracheostomy team. Increased surveillance and access to lower acuity, lower risk care were seen with weekly, dedicated MDT ward-rounds.
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