Abstract
Background: Transitioning long term care of pediatric patients with tracheostomy tubes and ventilator dependence from hospital to home is a comprehensive process that requires intense oversight and management to ensure patient safety. Our pediatric hospital has seen an increase in length of stay post pediatric tracheostomy tube placement since the COVID-19 pandemic (caregiver commitment to training and delays secondary to home nursing availability). We aim to evaluate the impact of the pandemic on the inpatient education program to support patients' transition to home with trained caregivers.
Methods: An- IRB approved retrospective review of pediatric patients with tracheostomy placement who elected a path of discharge to home were evaluated from 2010-2022. The home education plan for patients with tracheostomy and ventilator dependence includes at least 6 weeks of intensive inpatient education (Figure 1). Patient timelines were reviewed and evaluated to assess program efficiency and impact of discharge delays on length of stay and education time. Pre-COVID was defined as 2010-2019 and COVID/Post COVID was defined as 2020-2022.
Results: During the study period our pediatric hospital provided care, training, and education for 359 patients who required tracheostomy, ventilator support, and training to facilitate home discharge (Figure 2). When compared to the pre-COVID period, COVID/post-COVID tracheostomy tube placement increased 13%, time from tracheostomy tube placement to education program start increased by 26%, and time from tracheostomy tube placement to completed education decreased 3.7%, home RN availability related delays increased 442%, and average length of stay increased 2.7%.
Conclusions: While both the discharge delay time and length of stay increased in the post COVID period they did not increase at the same rate. There was also an increase in time from tracheostomy tube placement to initial education but a decrease in total time to complete the education program. A collaborative team management approach to tracheostomy tube placement, training track, education and discharge planning was able to overcome delays in discharge related to home nursing availability. Further studies must be done to evaluate the impact of COVID and discharge delays in other populations of technology dependent patients.
Figure 1 details the topics that are covered comprehensively as part of the home tracheostomy training program to two caregivers prior to discharge.
Figure 2 provides an overview of time benchmarks for our tracheostomy home education program from 2012-2022.
Footnotes
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