Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative
Objectives To analyze a multidisciplinary tracheostomy team’s effect on length of stay and cost. Methods An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and care...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-09-01
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| Series: | OTO Open |
| Online Access: | https://doi.org/10.1177/2473974X211045615 |
| _version_ | 1797427365020696576 |
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| author | Stephen R. Chorney MD, MPH Ashley F. Brown MS, CCC-SLP Rebecca L. Brooks MSN, APRN Candace Bailey Cindy Whitney RT Ashley Sewell RN Romaine F. Johnson MD, MPH |
| author_facet | Stephen R. Chorney MD, MPH Ashley F. Brown MS, CCC-SLP Rebecca L. Brooks MSN, APRN Candace Bailey Cindy Whitney RT Ashley Sewell RN Romaine F. Johnson MD, MPH |
| author_sort | Stephen R. Chorney MD, MPH |
| collection | DOAJ |
| description | Objectives To analyze a multidisciplinary tracheostomy team’s effect on length of stay and cost. Methods An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and caregiver education. Process measures included time to first education, speech-language pathology consultation rates, and pretracheostomy consultations. Outcome measures focused on the total length of stay, 30-day revisit rates after discharge, accidental decannulation rate, and standardized cost. Regression analysis was used to predict the program’s effect on length of stay and total cost. Results In total, 239 children met inclusion. The mean time to first education class was reduced from 13.7 to 1.9 days ( P < .001). The speech-language pathology consultation rate increased from 68% to 95% ( P < .001), and the presurgical consultation rate with the tracheostomy team increased from 14% to 93% ( P < .001). The length of stay decreased from 133 to 96 days ( P = .006). Total costs were lower for short admissions but higher for prolonged admissions. Revisits within 30 days remained stable over time (18%). Discussion Establishing a multidisciplinary tracheostomy team results in improvements in quality metrics when caring for children with tracheostomies. Controlling for associated factors showed the mean length of stay decreased significantly in the first full year of program implementation. Cost analysis estimated significant reductions for tracheostomy patients spending less time in the hospital. Implications for Practice A airway management program can positively affect tracheostomy processes and outcomes. |
| first_indexed | 2024-03-09T08:43:09Z |
| format | Article |
| id | doaj.art-c0a3d9c230334e209fc1106b614a7797 |
| institution | Directory Open Access Journal |
| issn | 2473-974X |
| language | English |
| last_indexed | 2024-03-09T08:43:09Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | OTO Open |
| spelling | doaj.art-c0a3d9c230334e209fc1106b614a77972023-12-02T16:04:47ZengWileyOTO Open2473-974X2021-09-01510.1177/2473974X211045615Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement InitiativeStephen R. Chorney MD, MPH0Ashley F. Brown MS, CCC-SLP1Rebecca L. Brooks MSN, APRN2Candace Bailey3Cindy Whitney RT4Ashley Sewell RN5Romaine F. Johnson MD, MPH6Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USAChildren’s Health Airway Management Program, Department of Pediatric Otolaryngology, Children’s Medical Center Dallas, Dallas, Texas, USAChildren’s Health Airway Management Program, Department of Pediatric Otolaryngology, Children’s Medical Center Dallas, Dallas, Texas, USAChildren’s Health Airway Management Program, Department of Pediatric Otolaryngology, Children’s Medical Center Dallas, Dallas, Texas, USAChildren’s Health Airway Management Program, Department of Pediatric Otolaryngology, Children’s Medical Center Dallas, Dallas, Texas, USAChildren’s Health Airway Management Program, Department of Pediatric Otolaryngology, Children’s Medical Center Dallas, Dallas, Texas, USADepartment of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USAObjectives To analyze a multidisciplinary tracheostomy team’s effect on length of stay and cost. Methods An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and caregiver education. Process measures included time to first education, speech-language pathology consultation rates, and pretracheostomy consultations. Outcome measures focused on the total length of stay, 30-day revisit rates after discharge, accidental decannulation rate, and standardized cost. Regression analysis was used to predict the program’s effect on length of stay and total cost. Results In total, 239 children met inclusion. The mean time to first education class was reduced from 13.7 to 1.9 days ( P < .001). The speech-language pathology consultation rate increased from 68% to 95% ( P < .001), and the presurgical consultation rate with the tracheostomy team increased from 14% to 93% ( P < .001). The length of stay decreased from 133 to 96 days ( P = .006). Total costs were lower for short admissions but higher for prolonged admissions. Revisits within 30 days remained stable over time (18%). Discussion Establishing a multidisciplinary tracheostomy team results in improvements in quality metrics when caring for children with tracheostomies. Controlling for associated factors showed the mean length of stay decreased significantly in the first full year of program implementation. Cost analysis estimated significant reductions for tracheostomy patients spending less time in the hospital. Implications for Practice A airway management program can positively affect tracheostomy processes and outcomes.https://doi.org/10.1177/2473974X211045615 |
| spellingShingle | Stephen R. Chorney MD, MPH Ashley F. Brown MS, CCC-SLP Rebecca L. Brooks MSN, APRN Candace Bailey Cindy Whitney RT Ashley Sewell RN Romaine F. Johnson MD, MPH Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative OTO Open |
| title | Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative |
| title_full | Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative |
| title_fullStr | Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative |
| title_full_unstemmed | Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative |
| title_short | Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative |
| title_sort | pediatric tracheostomy outcomes after development of a multidisciplinary airway team a quality improvement initiative |
| url | https://doi.org/10.1177/2473974X211045615 |
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