Tracheostomy Care Research Articles

Emergency Tracheostomy in Locally Advanced Anaplastic Thyroid Cancer.

Over 30% of cases may present with acute airway obstruction due to anaplastic thyroid cancer (ATC). In such situations, performing an emergency tracheostomy may be mandatory to save the life. A retrospective, single-centre study at our centre was conducted between 1 January 2021 to 31 December 2022. We had included 17 patients with asphyxia due to ATC and subsequently underwent tracheostomy for stridor. The overall survival (OS) ranged from 2days to 16months (median = 11months). The 30-day mortality was 17.6%. One-year overall survival was 36%. A statistically significant difference in the OS among patients with distant metastasis and Shin grade IV tracheal infiltration (p < 0.001, Log Rank (Mantel-Cox), CI:95%). The degree of tracheal deviation correlated with the patent age group (Pearson chi-square (pc), p = 0.031), type of anaesthesia used local versus general (pc, p < 0.001) and site of tracheostoma (pc, p = 0.028). The degree of tracheal infiltration correlated with the presence of distant metastasis (pc, p = 0.01) and OS (pc, p = 0.013). Tracheostomy in patients with ATC is performed in extreme circumstances to support an airway. Patients often require isthmectomy to obtain adequate access for a tracheostomy, highlighting the importance of having a highly experienced surgeon involved. An attempt to perform the tracheostomy in the ward or the emergency room under local anaesthesia should be avoided. Patients and relatives should be educated to communicate evolving issues and tracheostomy care in the patient's best interests, given the unusual context of ATC. Level of evidence, IV.

Nurses Experiences Regarding Tracheostomy Care at a Private Hospital ICU, Windhoek, Khomas Region, Namibia

Back ground: There is a rising recognition of the need for a harmonised, methodical approach to caring for patients with tracheostomy. Tracheostomy associated adverse events remain a destructive global problem, accounting for half of all airway-related death and hypoxic brain damage in critical care units Methodology: In this study, the researcher selected a qualitative, explorative, descriptive and contextual design to explore and describe nurses’ experiences regarding care of patients with tracheostomy care in ICU at Roman Catholic Hospital in Windhoek, Khomas Region. Findings: Four themes emerged from this study which indicated that participants experiences were commitment, scary experiences, strict supervision and lack of skills. Conclusion: The participants indicated that to care for a patient with tracheostomy one should be dedicated, more over participants experiences fear and need to be supervised as they lack necessary skills to care for tracheostomy

Effectiveness of Pictorial Education Handout on Tracheostomy Care Self-efficacy in Patients With Head and Neck Cancer and Family Caregivers: A Pilot Quasi-Experimental Study.

Learning and performing tracheostomy care are challenging for laypersons. Effective pictorial patient education handouts are needed for nonprofessional individuals to learn health management skills. The study aims to (1) evaluate the preliminary efficacy of the pictorial education handout on patients' and family members' self-efficacy in tracheostomy care and (2) identify demographic, psychological, and education-related factors associated with lower self-efficacy on tracheostomy care. This was a preliminary pilot study with a pretest-posttest design. We recruited a total of 39 participants, including 22 patients with head and neck cancer-related tracheostomy and 17 family caregivers in 2021. All participants received A3-size (297 × 420 mm) pictorial patient education handouts on how to suction and how to clean their tracheostomy at home. Pictorial education handouts showed a medium to large effect size on self-efficacy in the patient (Cohen D = 0.46) and caregiver participants (Cohen D = 0.78). Participants with higher anxiety were associated with a greater gain in self-efficacy with the pictorial patient education handouts ( r = 0.35, P = .027). Pictorial patient education handouts were effective tools for improving patients' and family caregivers' confidence in tracheostomy care, and it is particularly helpful for individuals with high anxiety with tracheostomy. Clinical nurses should use the pictorial education handouts not only to assist patients and family members on learning and practicing tracheostomy care but also to relieve anxiety associated with tracheostomy care at home.

The Effect of Web-Based Tracheostomy Care Game on Nursing Students’ Knowledge Levels and Their Views of The Process

Objective: This study investigated nursing students’ views of the effect of a web-based tracheostomy care game on their knowledge levels during the COVID-19 pandemic.&#x0D; Methods:This pretest-posttest single-group quasi-experimental study was conducted between April and July 2021. The study population consisted of all nursing students in Turkey. The sample consisted of 125 students who filled out the pretest and posttest forms. Participation was voluntary. Participants were recruited using snowball sampling method. Participants entered the website “trakeostomibakimi.com” They filled out the demographic characteristics questionnaire and the tracheostomy care knowledge test (TCKT) on the website. They downloaded the virtual tracheostomy care game on their computers. They played the game as much as they wanted and then filled out the posttest and the student opinion forms.&#x0D; Results: Participants had a higher mean posttest TCKT score than pretest score (p&lt; .05). They stated that the game helped them enjoy learning tracheostomy care and remember their prior knowledge and made them feel like they practiced in a real-life clinical setting.&#x0D; Conclusion: The web-based tracheostomy care game improved nursing students’ knowledge levels. There should also be online educational games tailored to other nursing areas.

Interdisciplinary assessment of tracheostomy care knowledge: An opportunity for quality improvement

PurposeA 2013 AAOHNS consensus statement called for reduced variation in tracheostomy care. Multidisciplinary approaches and standardized protocols have been shown to improve tracheostomy outcomes. This study aims to identify inconsistencies in knowledge in order to design standardized education targeting these areas to improve quality of care. Materials and methodsAn online, multiple-choice tracheostomy care knowledge assessment was administered to nurses and respiratory therapists in ICUs, stepdown units, and regular nursing floors, as well as residents in otolaryngology, general surgery, and thoracic surgery. The survey was administered and data were recorded using the Select Survey online platform. Results173 nurses, respiratory therapists, and residents participated in this study. Over 75 % of respondents identified correct answers to questions addressing basic tracheostomy care, such as suctioning and humidification. Significant variation was observed in identification and management of tracheostomy emergencies, and appropriate use of speaking valves. Only 47 % of all respondents identified all potential signs of tracheostomy tube displacement. Respiratory therapists with over 20 years of experience (p = 0.001), were more likely to answer correctly than those with less. Nurses were less likely than respiratory therapists to have received standardized tracheostomy education (p = 0.006) and were less likely than others to choose the appropriate scenario for speaking valve use (p = 0.042), highlighting the need for interdisciplinary education. ConclusionsAn interdisciplinary assessment of tracheostomy care knowledge demonstrates variation, especially in identification and management of tracheostomy emergencies and appropriate use of speaking valves. Design of a standardized educational program targeting these areas is underway.

Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

BackgroundTracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda.MethodsIn a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7 days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software.ResultsAll patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR = 1.8, 95%CI: 1.19 – 2.76), Bjork flap tracheal incision (RR = 1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR = 1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR = 1.22, 95%CI: 1.00 – 1.47).ConclusionPulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.

Online Searches Related to Total Laryngectomy.

To identify the most frequently asked questions regarding "laryngectomy" through an assessment of online search data. Google Search data based on the search term "laryngectomy" were analyzed using Google Trends and Search Response. The most common People Also Ask (PAA) questions were identified and classified by the concept. Each website linked to its respective PAA question was rated for understandability, ease of reading, and reading grade level. Search popularity for the term "laryngectomy" remained stable between 2017 and 2022. The most popular PAA themes were post-laryngectomy speech, laryngectomy comparison to tracheostomy, stoma and stoma care, survival/recurrence, and post-laryngectomy eating. Of the 32 websites linked to the top 50 PAA's, eleven (34%) were at or below an 8th grade reading level. Post-laryngectomy speech, eating, survival, the stoma, and the difference between laryngectomy and tracheostomy are the most common topics searched online in relation to "laryngectomy." These are important areas for both patient and healthcare provider education. N/A Laryngoscope, 133:2971-2976, 2023.

Protecting Sleep Hygiene in the PICU: A Quality Improvement Project.

To increase the number of nights without sleep interruptions for routine tasks in recovering PICU patients. Prospective quality improvement project. Single-center, free-standing, tertiary children's hospital. Patients admitted to the PICU for greater than 72 hours and eligible for early mobilization. A multidisciplinary sleep hygiene team was created to improve sleep hygiene in critically ill patients eligible for early mobilization. This team rewrote local nursing policies to avoid routine tasks between 11 pm and 5 am . The team provided periodic control chart updates to staff detailing progress made protecting sleep. Discussions of sleep hygiene were added to the daily goal sheet and a sleep hygiene order set was created. Finally, the PICU quality dashboard was modified to show whether a sleep hygiene order set was initiated in eligible patients. Routine tasks were defined as daily chest radiographs, baths, routine tracheostomy care, central line dressing changes, twice daily medications, weights, and Foley care. After a year of data collection, avoidance of routine pupillary examinations was added to the sleep protection criteria. Baseline data was collected for 2 months prior to the creation of the sleep hygiene team. Screening of eligible patients occurred 1 week each month. The data were analyzed utilizing control charts. Baseline data demonstrated 32% of PICU patients without sleep interruptions. The centerline increased to 58% after the initial interventions but dropped to 33% after inclusion of pupillary checks. Following the introduction of the daily goal sheet, sleep hygiene order set, and tracking on the quality board, 49% of patients went without interruptions. The initiation of a sleep hygiene team along with retiming routine tasks, daily discussions on rounds with the daily goal sheet, introduction of a sleep hygiene order set, and transparent tracking improved the percentage of patients with protected sleep.

Evaluation of Tracheostomy Care Self-Care Knowledge Among Adult Patients with Permanent Tracheostomy

Tracheostomy is a major surgery, to create an opening to provide airway patency at the 3rd or 4th cartilage ring in the anterior wall of the trachea. Tracheostomy has been considered the best life-saving procedure. Objective: To determine the impact of tracheostomy care intervention on self-care and assess level of anxiety. Methods: A crass sectional study was conducted on 34 patient’s takins from ENT and Patients age limit between 18 to 50 years, educational status was primary, metric and above, OPD patients, inpatients were included. Data were gathered using a standardized questionnaire on the evaluation of tracheostomy self-care. The SPSS version used to enter and evaluate the data. 21.0. The Chi-square test was used to determine whether there was a significant relationship between the patients; a p-value of 0.05 was deemed significant. Results: Total 34 participants enrolled in current study. 37.1% were 41 -50 years old. 60% of participant’s were male. Majority (76.4%) of the patients have poor self-care knowledge regarding tracheostomy care. Only 14.7% patients gave good self-care knowledge. majority of participant’s responses haven poor self-care. The older patients 41 to 50 years, female and primary education patients have poor self-care knowledge. Conclusions: After tracheostomy procedure it is very important to maintain self-care and avoid to infection. It is concluded from this study that self-care not good on their evaluation, education intervention to enhance on self-care and reduced the level of anxiety for patients with tracheostomy at home.

Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes.

Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days ( P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.

Insights on Competency and Knowledge Related to the Tracheostomy Care of Nurses at a Tertiary Referral Hospital in Oman.

Objectives: To assess the efficacy of current knowledge and competency of tracheostomy care providers in inpatient setting. Methods: A real-time questionnaire-based cross-sectional study was carried out on 34 tracheostomy nursing care providers from different in patient settings. There were 50 questions in 8 sections, covering most of the aspects and steps of tracheostomy. The assessment of efficacy of the current knowledge and competency of tracheostomy care were assessed based on the response of the survey. Results: The overall competency of nursing for tracheostomy care was only 63.5%. In 5.9% of them, it was less than 50%. 30 (88.2%) tracheostomy care givers answered between 50% and 80% of the questionnaire correctly, and only 2 (5.9%) of them managed to get higher than 80%. Conclusion: The competency and knowledge regarding the tracheostomy care is low and the study highlight the importance of staff education for post-operative tracheostomy care to increase the level of care and to reduce adverse events. A re audit is needed to ensure that the care is improved qualitatively after training.

Elective Tracheostomy During Covid-19 Pandemic- A Tertiary Care Centre Experience.

: The aim of our study was to present an experience of elective tracheostomy in COVID-19 patients at our institute. The present prospective study was conducted, after approval by Institutional Ethics Committee, in the Department of ENT, SMGS Hospital, GMC Jammu from May 2020 to March 2021 over 60 patients having need for prolonged mechanical ventilation and having tested positive for COVID-19 with nasopharyngeal swab on rtPCR assay testing. Detailed information regarding following aspects was gathered :Age, Gender, Comorbidities (Diabetes, Cardiovascular disease, Pulmonary disease, Malignancy), time of endotracheal intubation to tracheostomy, time to wean sedation after tracheostomy, time to wean mechanical ventilation after tracheostomy, surgical complications, mortality, any health care worker in operating team getting infected by SARS-CoV-2. All 60 patients underwent Elective Open Tracheostomy Bed-side in the ICU section of our institute. The mean age of presentation was 55.9 ± 2.34 years, with male preponderance. The most common indication for tracheostomy was ARDS (Acute Respiratory Distress Syndrome) (56.6%). Out of 60 patients, co-morbidities were present in 44 patients (73.3%). The mean time between endotracheal intubation and tracheostomy was 12.2 ± 4.9 days. The mean time to wean mechanical ventilation after tracheostomy was 10.4 ± 2.31 days. The mean time to wean sedation was 2.2 ± 0.83 days. There were no deaths during the procedure. Out of 60 patients, 5 patients (8.3%) died due to complications of COVID-19. Our study provides important clinical data (such as timing of tracheostomy, pre-operative evaluation of patients, recommendations during procedure, outcomes of tracheostomy and postoperative care) on this threatening issue of tracheostomy in COVID-19 patients and might be of immense help to various Otorhinolaryngologists who are dealing with the same situation.

Critical Care Nurses' Knowledge of Tracheostomy Care.

Tracheostomy care is a standard procedure that nurses perform in Critical Care Units (CCUs) to reduce complications from tracheostomy. The literature indicates a clear variety of care and practice in managing tracheostomy patients within the healthcare system. This study was conducted to assess the knowledge level of tracheostomy care among nurses in CCUs in Jordanian hospitals. A cross-sectional descriptive design was used for this study. A convenience sample of 260 nurses working in the CCUs of four government hospitals completed a self-reported structured questionnaire. Data were collected from January 2021 to March 2021. A t-test and one-way Analysis of Variance (ANOVA) were used to assess the differences among socio-demographic variables in terms of knowledge score. The result revealed that the level of knowledge was suboptimal. There was a statistically significant difference in the mean level of knowledge regarding tracheostomy care (in all dimensions) by age (F = 22.595, p < 0.001), educational level (F = 355.30, p < 0.001), and work experience (F = 13.63, p < 0.001). For gender, there was a statistically significant difference in knowledge of the tracheostomy suctioning dimension (p = 0.001). The level of knowledge among nurses regarding tracheostomy care was moderate, indicating an urgent need for education.

New Graduate Orientation: Has Competency Confidence Changed Since Covid 19

Student nurses and new graduate nursing students perceived a lack of preparation to clinical practice due to the challenges of the Covid 19 pandemic. Hospitals needed to pivot hybrid orientation programs and nursing schools needed to adjust clinical time and experiences to meet new Covid guidelines and mandates. This article compared the new graduate nurse confidence surveys of 1,320 nurse residence in a Pennsylvania healthcare network from 2019-2022 to determine if the new graduate nurses’ perceived confidence when performing basic nursing skills such as medication administration, tracheostomy care, ventilator care, wound care, EKG interpretation, nasogastric tube management, central line care, chest tube management, blood administration, and bladder catheter insertion had changed. The results of this study suggested more confidence by new graduate nurses in 2020-2021 as compared to 2019 and 2022. The results indicate that these changes in nursing school clinical and hospital orientations did not impact the 6 month confidence survey negatively. In fact, confidence score were less in 2019 and 2022 when traditional “live” programming was offered.

Attitude and practices of tracheostomy care among nursing staff in Saudi Arabia

BackgroundIn many regions of the world, tracheostomy care is a major health concern. Many patients die as a result of nurses' lack of awareness regarding tracheostomy care. This study was carried out to report the acquired training, clinical experience and team approach while caring for patients with tracheostomies and then evaluate these aspects on nurses’ confidence in caring for these patients.MethodsA cross-sectional descriptive study involving a self-administered questionnaire was carried out among nurses from October 2020 to June 2021. A self-administered questionnaire including questions on sociodemographic characteristics, tracheostomy training and support and confidence in caring for patients with tracheostomies. It was disseminated electronically to the nurses working in a tertiary medical center in Saudi Arabia with multiple reminders. Group difference was determined using t test and chi square tests appropriately with a set p value to less than 0.05.ResultsA total of 315 nurses with different educational backgrounds were included. The majority were females, middle aged and gained their nursing degree from outside the country. Over 30% of the nurses cared for patients with tracheostomies while more than two thirds did not receive adequate training to care for this patient population. Confidence was reflected in the working units, the time spent caring for these patients and the number of patients cared for. Additionally, nurses caring for children and adults with tracheostomies were more confident in their care than those caring for adolescents and older adults.ConclusionContinuous training and competency evaluation are vital in delivering optimal care. Confidence level is impacted by training received and by the presence of assisted ventilation. Future studies should aim for a national representation of this topic to inform policy and practice.

Postoperative photography reduces incorrect wound breakdown diagnoses in tracheostomy

PurposeThis study was performed to investigate the effect of including immediate postoperative photographs of a tracheostomy site on diagnoses (correct and incorrect) of wound breakdown in a pediatric patient population. Materials and methodsChart review was performed of all patients from 2017 to 2019 who underwent a tracheostomy. Within this time span, the practice of the hospital changed such that postoperative photography was taken of the tracheostomy site. There were no changes in in-service training protocols over this time. Wound breakdown diagnoses were examined prior to and after the intervention. Diagnoses were categorized by severity according to the National Pressure Ulcer Advisory Board. Diagnoses were then divided into correct or incorrect based on examination by physician teams at the time of the diagnosis. ResultsForty five patients underwent a tracheostomy during the study period. When comparing the two groups, there was a reduction in all wound breakdown diagnosis by 91 %, and those diagnoses which were entered into the chart after the photos were verified as correct. ConclusionsWithout appropriate context as to the nature of tracheostomy wounds, many providers may incorrectly grade a healthy wound as wound degradation, which can affect care, reimbursement, and hospital ratings. We present our findings of placing an intraoperative wound photo in the patient's electronic medical record as a reference should wound concerns arise. We believe this is an easy action which can enhance patient care, decrease unnecessary work, and provide an accurate documentation of tracheostomy care pathways and results.

Basic principles of respiratory care for patients with tracheostomy

Tracheostomy is a commonly performed procedure in the intensive care unit. Selection of patients for this procedure should be done carefully after understanding the individual risks and benefits. Optimal care begins with the selection of an appropriate tube for the patient from the wide range of tubes available today. Care of the cuff, proper patient positioning, humidification of inspired gases and a well secured tube would avoid undue complications. Adequate support needs to be given to facilitate communication and swallowing. Emergency equipment for tube change should be readily available. A good tracheostomy care plan also includes oral hygiene, infection control practices, wound care and provision of adequate nutrition. Decannulation may fail, if performed without proper assessment of functional and anatomical changes in the airway. A good understanding of the basic principles of respiratory care will provide better outcome in patients with a tracheostomy

DOMESTIC MEDICAL MANAGEMENT BY HOME VISIT PHYSICIAN FROM A TERTIARY CENTER IN A RESOURCE LIMITED SETTING - A STRUCTURED PROTOCOL

An inordinate high demand for home visit (HV) physician medical team in third world and developing countries. Aim : The study is to deliver medical treatment at home in emergency and immovable situations. We assessed, Introduction : managed and analyzed types of disorders, treatment outcome, and instructions to home caregivers about monitoring and intimating clinical response after HV and tele-consultation. Strict adherence to protocol based res Discussion : ults proved 99.5% convincing management with 0.5% death in terminally ill. Mean average age of 75 yrs for males and 71 yrs for females. General medical illness is 70.7%, Acute emergency 6.1%, Catheterisation 12.2%, Tracheostomy care 2.2%, Wound dressing 6.6%, Sutures 0.6%, Parenteral infusion 1.1%. We noticed HV is Conclusion : essential in third world countries and to include in policy making by healthcare. Limitation and recommendation : Can be overcome by increasing trained manpower.

An all-wales virtual reality project-innovation, design and collaboration to enhance healthcare education

The potential for immersive technologies to augment healthcare training is gaining significant interest. However, its applicability and effectiveness are yet to be fully understood. This project was a response from a bid released by the Cardiff Capital Region to undertake a rapid innovation project, consisting of 3 main phases: 1) feasibility; 2) development; and 3) testing, across Welsh Health Boards. Project governance was provided via the Small Business Research Initiative (SBRI) in Clinical Excellence, a project board, and a project team with clinical and educational expertise, alongside Virtual Reality (VR) industry and academic partners. We aim to explore the formation of a virtual reality training package with a multi-centred collaborative project to overcome the current challenges of respiratory education, with a particular focus on tracheostomy care, to meet the challenges of the COVID-19 pandemic and beyond [1]. Phase 1 focused on the development of minimally viable solutions with a key focus on clinical content accuracy and education standards for single user learners. Phase 2 progressed to further develop the VR-based solutions including a multi-player system and virtual debriefing room, allowing the team to focus on key simulation-based learning best practice standards within the design and build [2]. Phase 3 is when system testing occurred over an 8-week period, across 6 Health Boards in NHS Wales involving over 100 multi-professional clinicians commencing in February 2022. On site hospital clinical education session feedback regarding use of the system and perceived opportunities were highly favourable in terms of ease of use, potential for VR in practice, and providing flexibility for mass training needs. Multi-user training was particularly well received. The limitations were lack of resource and time to combine a formal research project regarding the educational impact within busy health boards. This is planned for the next phase. Empirical evidence from other industries demonstrates VR technology is an effective and efficient way of improving training [3]. Developing VR solutions to support healthcare training needs involves a collaborative approach with Health Boards, industry, and academic partners. The design, build, and implementation approach can embed simulation best practice standards to form innovative educational solutions to the challenges seen in the delivery of mass healthcare education. Formal research is required to begin to measure such factors as education transference, patient care impact, and return on investment questions. 1. Chiang DH, Huang CC, Cheng SC, Cheng JC, Wu CH, Huang SS, Yang YY, Yang LY, Kao SY, Chen CH, Shulruf B. Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre–post study. Medicine. 2022;101(2):e28570–e28570. 2. Rossler K, Molloy MA, Pastva AM, Brown M, Xavier N. Healthcare Simulation Standards of Best Practice 3. Manolakis K, Papagiannakis G. Virtual Reality simulation streamlines medical training for healthcare professionals. Journal of dentistry. 2022;121:103987.

Reduction in inpatient readmissions following implementation of a dedicated tracheostomy care team.

Pediatric tracheostomy patients are at risk for lengthy hospitalizations and multiple readmissions with rare but potentially disastrous tracheostomy-related complications. Several centers have formed multidisciplinary teams for pediatric tracheostomy patients to coordinate care and enhance caregiver education to aid in safe care delivery. Current literature has shown encouraging change in pediatric tracheostomy care with these interventions, but there remains an opportunity to better gauge alterations of morbidity. We aimed to review our institution's experience before and after development of a pediatric tracheostomy care team. Pediatric tracheostomy patients (<19 years) who underwent tracheostomy between January 2010 and June 2020 were included. A pediatric tracheostomy care team including a nurse practitioner and registered nurse was established in July 2017. Rates of readmission, outpatient visits, decannulation rates, and mortality are examined before and after implementation of the care team. Bivariate and multivariable analyses were utilized. 296 patients were included with 128 patients in the pre-intervention group, 82 in the post-intervention group, and 86 completing cross-over care. The groups were comparable in age at tracheostomy, tracheostomy indication, and underlying comorbidities. Mean outpatient visits per tracheostomy-year in the post-intervention group were higher than the pre-intervention group (2.3 vs. 2.2, p=.02). Fewer mean inpatient admissions per tracheostomy-year (0.02 vs. 0.11, p=.03) were observed after intervention. Time to decannulation did not differ significantly between the two groups (p=.57). Implementation of a dedicated tracheostomy care team may help decrease inpatient admissions for tracheostomy-specific complications.