Effects of dedicated inpatient rounds on tracheostomy care in children

Objective

To describe our institution's weekly multidisciplinary tracheostomy team (MDT) rounds and assess their effect on increasing routine surveillance and low acuity interventions for patients with tracheostomies under two years of age.

Study design

Retrospective.

Setting

Tertiary referral children's hospital.

Methods

All inpatient encounters below age two with an existing tracheostomy were included. Patients receiving tracheostomies during their admission were excluded. All comparisons were made between admissions one year before and after implementation of tracheostomy team rounds.

Results

One hundred thirty admissions (43 unique patients, 51 % female) were found, of which 56 occurred one year before the start of weekly rounds. Twenty-three percent of admissions were related to the patient's tracheostomy. Rounds increased otolaryngology encounters during an admission (OR: 2.38, 95 % CI [1.16, 4.89], p = 0.018). Stomal concerns noted during admission decreased with the implementation of rounds (OR: 0.13, 95 % CI [0.03, 0.66], p = 0.014). The number of surveillance direct laryngoscopy and bronchoscopy (DLB) preformed as recommend from MDT rounds increased after the implementation of rounds (OR 5.58, 95 % CI [2.09, 14.9], p < 0.001) as did other interventions recommended during rounds but not done immediately at bedside (OR 9.66, 95 % CI [3.40, 27.5], p < 0.001).

Conclusion

Aspects of care for children less than two years of age with tracheostomies were improved after implementation of the multidisciplinary tracheostomy team. Increased surveillance and access to lower acuity, lower risk care were seen with weekly, dedicated MDT ward-rounds.