O2062: Implementation of a Novel Fresh Tracheostomy Program in a Community Pediatric Hospital

Background: Historically, fresh tracheostomies were only available at primary pediatric medical centers. This report involves a novel multidisciplinary effort to expand scope of care to include fresh tracheostomies in a pediatric community hospital setting along with providing training of all disciplines. Indications for a tracheostomy in a pediatric patient can vary from congenital and acquired airway anomalies, chronic interstitial pulmonary diseases, other disease processes requiring long term ventilation and/or protection from aspiration and/or pulmonary toilet, and more. The hospitalization process of placing a fresh tracheostomy not only involves the surgical procedure but the intensive post-operative care to allow for adequate healing and providing the education for patients and families involved in managing the tracheostomy at home.

Methods: The creation and implementation of a novel hospital wide program required the expertise of hospital leadership, Critical Care, Anesthesiology, Otolaryngology, and simulation center (Table 1).
Four steering committees were created:
● Workflow and operations: Modification of current hospital wide and departmental policies, procedures, and workflows
● Scope of care: Create criteria for admission
● Education: Implementation of training and education for all teams
● Simulation: Test workflow and identify areas of safety risks

Results: The goals of each committee were accomplished over approximately 12 months. Since implementation, we have provided a total of 10 fresh tracheostomies and tracheostomy education to an additional 7 families. The average length of stay from fresh tracheostomy placement to discharge was 18.8 days compared to 32 days at our primary medical center. Contributions that led to decreased length of stay were the initiation of staff engagement and immediate education with families post tracheostomy placement. By allowing patients to receive surgery and education at the community campus, a total of 532 ICU days has been offset from our primary medical center.

Conclusion: Our team successfully expanded our scope of practice and easier access to care for families within the community we serve while offsetting valuable ICU days at our primary medical center.