Safe Transitions for Tracheostomies (SAFE-T2)

Background: The number of medically complex children in the United States has been drastically increasing with advances in medicine, including children who are tracheostomy and ventilator dependent. Children with moderate-to-severe disabilities and tracheostomy-dependence have early hospital readmission rates and an increased risk of death from respiratory illness.

Caregivers are aware of the high-risk nature of tracheostomy-dependence. As such, anxiety and discomfort are common when transitioning a child’s complex medical care to the outpatient setting. While caregivers are often trained in basic life support, very few studies have assessed the skills, knowledge, or attitude of caregivers regarding caring for their child in the out of hospital setting.

We initiated an intervention around the time of hospital discharge at Shands Children’s Hospital to improve outcomes of children with tracheostomies. The objective of this project is to improve caregivers’ skills, knowledge, and attitude when managing common pediatric tracheostomy-related critical events.

Methods: English speaking caregivers of children with new tracheostomies were recruited to participate in the program. Subjects completed the following five steps: 1) Pre-training assessment, 2) Information Review, 3) Simulation-based Training, 4) Post-Training Assessment, 5) Discharge with SAFE-T2 Go Bag. All five steps of the program were completed prior to hospital discharge.

A second simulation was conducted approximately 2-to-4 weeks after the first simulation. Knowledge, skills, and attitude were measured by assessments administered at each simulation session. Simulations were conducted using a low-cost, modified, low-fidelity mannequin and standardized tracheostomy-related equipment.

Statistical analysis was performed by calculating 95% confidence intervals for the data ranges and performing two-tailed t-test to compare results at different time points.

Results: There was a statistically significant increase in skill scores (p=0.003) between the first simulation (88% ± 19.6%, 95% CI) and the second simulation (100% ± 0%, 95% CI). There was no statistically significant increase (p=0.89) in knowledge scores before the first simulation (80% ± 13.5%, 95% CI) and after the second simulation sessions (79% ± 15.5%, 95% CI). There was no statistically significant increase (p=0.13) in composite attitude scores before the first simulation (3.95 ± 0.56, 95% CI) and after the second simulation sessions (4.58 ± 0.76, 95% CI).

Conclusion: Simulation training for parents and caregivers is associated with a statistically significant improvement in resuscitation skills related to tracheostomy emergencies. Simulation training is a potential educational tool for caregivers to improve both patient and caregiver-related outcomes in children with tracheostomy dependence.