Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

Abstract

Improvements in neonatal care have increased the need for long-term interventions, such as tracheostomy, in the pediatric population. Because children with a tracheostomy experience high morbidity and mortality, there is a need for more coordinated care for this growing complex pediatric population. In 2011 and 2012, studies reported that up to 14% of the patients who received a tracheostomy experienced perioperative or postoperative tracheostomy-related adverse events (TRAEs).¹ Up to 30% of tracheostomy admissions are associated with an airway-related adverse event.² A national survey³ indicated that patients who have received a tracheostomy experience 1 catastrophic event every 10 years, with about half of those events leading to either death or permanent disability. Multidisciplinary coordinated care has been shown to effectively reduce the occurrence of adverse events in patients with a tracheostomy.⁴ The following 5 key drivers of tracheostomy care have been established to help implement quality-driven care: standardization of care, broad staff education, patient and family involvement, monitoring of outcomes, and multidisciplinary collaboration.⁵ In 2015, Boston Children’s Hospital (BCH), Boston, Massachusetts, created a multidisciplinary tracheostomy team (MDT) to implement these key drivers.