Employing a multidisciplinary tracheostomy team to improve the care process of pediatric patients

Describe the varied components (staff education, system capability, family education) of a multidisciplinary, inpatient pediatric tracheostomy team.

After its initiation in January 2019, a multidisciplinary tracheostomy team at a tertiary pediatric medical center developed an improvement plan with multiple interventions, utilizing a mixed methodology of features from Lean in Medicine and the Institute for Healthcare Model for Improvement. Interventions included education modules, the creation of a house-wide collaborative, adjustments to the electronic documentation tab, and the initiation of real-time reporting of adverse events. Outcomes included head-of-bed emergency equipment compliance, frequency of a pre-tracheostomy care talk, documentation accuracy in the electronic medical record, and adherence to standards-of-care regarding pediatric patients with tracheostomies.

Interventions were implemented, and data was collected from January 2019 to June 2024. With the implementation of multiple tracheostomy team interventions, head-of-bed emergency equipment compliance increased from 55 % to 100 % over the course of 4 years. Additionally, the frequency of pre-tracheostomy care talks provided to patients scheduled to receive a tracheostomy increased by 400 % over the span of nine months. Changes in documentation accuracy and adherence to standards-of-care were variable.

The pediatric tracheostomy team succeeded in increasing head-of-bed emergency equipment compliance and opportunities for caregiver education. This study demonstrates the additive benefits of a multi-faceted project to improving care in pediatric tracheostomy patients.