Melanie Kitagawa, MD, MHA
Baylor College of Medicine/ Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Danielle Guffey, MS
Mrs.
Baylor College of Medicine, United States
Disclosure information not submitted.
Thomas Fogarty, III, MD
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston, Texas, United States
Disclosure information not submitted.
Kevin Roy, MD
Associate Professor
Texas Childrens Hospital, United States
Disclosure information not submitted.
Title: Pediatric Tracheostomy and Caregiver Education: Experience from an Academic Pediatric Center
Introduction: Children who undergo a new tracheostomy require intensive caregiver education. Nationally, average lengths of stay (LOS) for children with a new tracheostomy range from 90 to 250 days. At Texas Children’s Hospital (TCH) in 2002-2003, 81 children received a tracheostomy with an average LOS of 46 days. Utilization of a defined caregiver education program improves patient outcomes. We hypothesize that there is an increase in the number of children receiving a tracheostomy per year at TCH and that caregiver education is ongoing for a significant portion of their LOS.
Methods: We did a retrospective chart review of patients admitted to TCH from June 2018 to June 2020 with a new tracheostomy. Any patient under the age of 25 years old whose caregivers completed our TCH tracheostomy education program in our Transitional Intensive Care Unit (TICU) was included. We collected patient and admission characteristics which were summarized using median with 25th and 75th percentiles, and frequency with percentage. All analyses are performed using Stata v 15.
Results: We included 102 patients in our study and had a median age of was 1.3 years. Over 90% of the patients live in Texas with 65% of those patients living in the Houston metropolitan area. Most of our study cohort was covered by Medicaid. They come from a household with an average of 4.6 people within the home with a median maternal age of 30 years and median paternal age of 33 years. Of the patients, 75 % were initially admitted to the PICU, 22% to the NICU, and 4% to the CICU. The study cohort had a median hospital LOS of 124 days with a median TICU LOS of 51 days. Over 90% of the patients were discharged home. The median number of days to complete the tracheostomy education pathway was 50 days with over half of the total LOS having education ongoing for the caregivers. Within the study cohort, 83% of patients had at least two caregivers trained. There was a median of 2 readmissions for this cohort which included admissions for planned procedures.
Conclusions: There are increasing rates of children receiving tracheostomies with prolonged caregiver education. We have found an educational pathway that keeps patients safe at home with low readmission rates. However, there the opportunity to evaluate the underlying etiology for the increasing education times.