The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

Thida Ong; C. Carrie Liu; Leslie Elder; Leslee Hill; Matthew Abts; John P. Dahl; Kelly N. Evans; Sanjay R. Parikh; Jennifer J. Soares; Amanda M. Striegl; Kathryn B. Whitlock; Kaalan E. Johnson

doi:10.1177/0194599820911728

journal article Mar 24, 2020

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

Thida Ong

C. Carrie Liu Leslie Elder Leslee Hill Matthew Abts John P. Dahl

Kelly N. Evans Sanjay R. Parikh Jennifer J. Soares Amanda M. Striegl Kathryn B. Whitlock Kaalan E. Johnson

Otolaryngology–Head and Neck Surgery Vol. 163 No. 2 pp. 221-231 · Wiley

View at Publisher Save 10.1177/0194599820911728

Abstract

ObjectiveTo describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy‐related mortality in outpatient tracheostomy‐dependent children (TDC).MethodsAn interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community‐based nurses on TDC‐focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic. The primary outcome was annual unanticipated mortality after hospital discharge from tracheostomy placement before and after the initiative.ResultsIn the 5 years before and after the initiative, 131 children and 155 children underwent tracheostomy placement, respectively. At the end of the study period, the institution sustained Trach Safe practices: (1) surveillance bronchoscopies increased from 104 to 429 bronchoscopies, (2) the course trained 209 community‐based nurses, and (3) the survey was used in 488 home ventilator clinic visits to identify near‐miss airway events. Prior to the initiative, 9 deaths were unanticipated. After Trach Safe implementation, 1 death was unanticipated. Control chart analysis demonstrates significant special‐cause variation in reduced unanticipated mortality.DiscussionWe describe a system shift in reduced unanticipated mortality for TDC through 3 major practice changes of the Trach Safe Initiative.Implication for PracticeDeath in a child with a tracheostomy tube at home may represent modifiable tracheostomy‐related airway events. Using Trach Safe practices, we address multiple facets to improve safety of TDC out of the hospital.

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References

Details

Published: Mar 24, 2020
Vol/Issue: 163(2)
Pages: 221-231
License: View

Authors

T

Thida Ong

Pediatric Pulmonary and Sleep Medicine University of Washington Seattle Washington USA; Seattle Children’s Hospital Seattle Washington USA

C

C. Carrie Liu

Pediatric Otolaryngology–Head and Neck Surgery Seattle Children’s Hospital Seattle Washington USA; Otolaryngology–Head and Neck Surgery University of Washington Seattle Washington USA

L

Leslie Elder

Seattle Children’s Hospital Seattle Washington USA

L

Leslee Hill

Seattle Children’s Hospital Seattle Washington USA

M

Matthew Abts

Pediatric Pulmonary and Sleep Medicine University of Washington Seattle Washington USA; Seattle Children’s Hospital Seattle Washington USA

J

John P. Dahl

Pediatric Otolaryngology–Head and Neck Surgery Seattle Children’s Hospital Seattle Washington USA; Otolaryngology–Head and Neck Surgery University of Washington Seattle Washington USA

K

Kelly N. Evans

Seattle Children’s Hospital Seattle Washington USA; Craniofacial Medicine University of Washington Seattle Children’s Hospital Seattle Washington USA

S

Sanjay R. Parikh

Pediatric Otolaryngology–Head and Neck Surgery Seattle Children’s Hospital Seattle Washington USA; Otolaryngology–Head and Neck Surgery University of Washington Seattle Washington USA

J

Jennifer J. Soares

Anesthesiology, Virginia Mason Seattle Washington USA

A

Amanda M. Striegl

Pediatric Pulmonary and Sleep Medicine University of Washington Seattle Washington USA; Seattle Children’s Hospital Seattle Washington USA

K

Kathryn B. Whitlock

Center for Clinical and Translational Research Seattle Children’s Hospital Seattle Washington USA

K

Kaalan E. Johnson

Pediatric Otolaryngology–Head and Neck Surgery Seattle Children’s Hospital Seattle Washington USA; Otolaryngology–Head and Neck Surgery University of Washington Seattle Washington USA

Cite This Article

Thida Ong, C. Carrie Liu, Leslie Elder, et al. (2020). The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients. Otolaryngology–Head and Neck Surgery, 163(2), 221-231. https://doi.org/10.1177/0194599820911728

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

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