Improving Efficiency of Caregiver Tracheostomy Education for Children

Abstract

Background: Caregiver education and training for children with tracheostomies is multi-faceted and complex. The process can be lengthy as there are many aspects of care that must be learned, practiced and demonstrated proficiently before discharge home can occur. The process is generally longer for children requiring a home ventilator due to additional training needs. There are on average 20-25 new tracheostomies performed per year at our pediatric institution. The caregiver tracheostomy education process is managed by dedicated respiratory therapists. Changes in documentation and communication were made to the education process in efforts to improve efficiency and reduce the time to complete training as part of an institutional quality improvement program. Methods: A tracheostomy list was created within the electronic medical record (EMR) system to identify all inpatients with a tracheostomy. Communication of training status was documented in the treatment team section of the EMR. Education record documentation was revised for tracheostomy teaching specific points. The length of time between the tracheostomy class and completed training was compared before and after the process changes. Inclusion criteria were children who had a tracheostomy placed during July 2017 – January 2019 and whose caregivers received training. Children who had not yet discharged were excluded. Results: There were 38 children for whom caregiver tracheostomy education was completed during the defined timeframe. Three were excluded due to ongoing hospitalization. Of the remaining 35 children, 21 (13 ventilated, 8 non-ventilated) received education before changes were implemented and 14 (9 ventilated, 5 non-ventilated) afterwards. The length of time to complete education was reduced for both ventilated and non-ventilated children. See table. Time from completed training to discharge was relatively unchanged. Conclusions: Improvements in treatment team communication and EMR documentation were effective in reducing the time to complete caregiver tracheostomy education. Time to discharge can be influenced by many factors not related to the training process. However, completing the training sooner may allow the opportunity for more time to practice skills before discharge.