Outcomes of Children With Tracheostomy Before and After Implementing Caregiver Simulation-Based Tracheostomy Education.

Objective: Tracheostomy-related emergencies (TRE) such as decannulation, cannula obstruction, and hemorrhage contribute significantly to mortality, emergency department (ED) visits, and hospitalizations. High-fidelity simulation-based training (SBT) for family caregivers can improve their competence in TRE management. The aims of the study were to compare the frequency of ED visits, readmissions, and mortality in children with tracheostomy based on caregiver completion of SBT.

Study design: Retrospective study.

Setting: Single-center academic children's hospital.

Methods: Children who underwent tracheostomy from 2014 to 2020 were studied, with cohorts based on caregiver completion of SBT. Patients were followed for 1 year following hospital discharge after tracheostomy. The frequency and reasons for ED visits, readmissions, and mortality were evaluated.

Results: Among the 158 patients who met inclusion criteria, the caregivers of 83 (53%) patients completed SBT. Overall mortality was significantly lower (P < .001) among patients whose caregivers completed SBT (2%) compared to patients whose caregivers did not complete SBT (17%). There was no significant difference in mortality due to tracheostomy-related causes based on caregiver completion of SBT (P > .99). There were no significant differences in the total ED visits (P = .44) and readmissions (P = .11), or tracheostomy-related ED visits (P = .61) and readmissions (P = .45) based on caregiver completion of SBT.

Conclusion: Overall mortality was significantly lower among patients whose caregivers completed SBT. The frequency of ED visits, readmissions, and mortality due to tracheostomy-related causes did not differ between the groups. Although high-fidelity SBT may augment caregiver competence in TRE management, further study is needed to determine if SBT can measurably impact tracheostomy-related outcomes.