O1009: Trach No Prisoners- restructuring Peri-tracheostomy Management to Avoid Lengthy Hospitalization

Background: Due to recent programmatic growth, Dell Children's Medical Center (DCMC) experienced a rapid increase in new tracheostomies. This brought to light deficiencies in the home caregiver training process, including over-reliance on family education from rotating critical care staff, under-utilization of print and video resources, lack of social work involvement to remove family barriers to participation in care, and overall diminished expectations for post-tracheostomy length of stay (PTLOS). Community-wide shortages of home nursing compounded the problem. These issues prompted us to improve our educational process for family caregivers so they could safely care for their newly trached child, and be discharged home faster.

Methods: A multidisciplinary team consisting of nursing, nursing education, respiratory therapy, speech therapy, case management, social work, and physicians developed a platform to competently and efficiently prepare parents for home tracheostomy care using a 14-day process and education plan. This new platform included expanded pre-op counseling and the addition of a pre-trach care conference to identify barriers and initiate focus on discharge needs before the trach is placed. Standardized education was created and implemented for all team members to establish consistent training methods. A roadmap (see Image 1) was created as a visual aid to show parents and team members the progress of the tracheostomy education pathway. Parent didactics began postoperative day one, and continued via scheduled, repetitive skill teach-back assessment, and room-in readiness evaluation. ENT providers established the frequency of tracheostomy changes based on stoma evaluation. In conjunction weekly multidisciplinary trach rounds were completed to assess progress and identify any continued barriers.

Results: During the period from November 2020 to December 2021, 32 tracheostomy patients were followed, while 78 home caregivers were instructed using the new education plan. PTLOS was decreased by 44% compared to historical controls, allowing families to return home an average of 35 days earlier (see Graph 1). Readmission rates were unchanged.

Conclusion: Multidisciplinary focus upon pre-tracheostomy planning, standardized staff education, and an efficient family education plan can reduce PTLOS and prepare competent caregivers without increasing hospital readmission rates.