Effect of Dedicated Inpatient Rounds on Tracheostomy Care in Children

Introduction: Children with tracheostomies are a vulnerable and medically complex population. Specialist care teams could improve care via increased surveillance, access to care, and lower-acuity encounters. Otolaryngologists conducted dedicated weekly inpatient tracheostomy rounds beginning 12/14/20 at a pediatric tertiary care center.

Methods: All inpatient encounters below age 2 with an existing tracheostomy were included. Patients receiving tracheostomies during their admission were excluded. Generalized linear mixed and linear mixed models were used to compare multiple outcomes one year pre to one year post implementation.

Results: A total of 130 encounters from 43 unique patients were observed with 43% (n=56) of the encounters occurring one year pre implementation and 57% (n=74) encounters occurring post implementation. Mean age of patients was 1.01 years ± 0.44 with 52% of patients being female. Implementation of tracheostomy rounds resulted in significantly higher percent probability of the patient being seen by ENT during admission (48% pre 95% CI [35% – 61%] vs. 69% post 95% CI [57% - 79%], P =0.02). Bedside interventions (tracheoscopy, trach change, stoma care) decreased from 79% pre implementation to 49% post implementation (OR 0.27, 95% CI [0.09, 0.83], P=0.02). Interventions not done at the bedside (inpatient DLB, inpatient imaging, short interval outpatient follow up) increased from 18% pre implementation to 69% post implementation (OR 9.72, 95% CI [2.91, 32.47], P=0.0005). Implementation of rounds resulted in a decrease in hospital length of stay of 1.54 days (95% CI [-4.2, 1.11], P=0.2527) but was not significantly associated with increased planned encounters (OR 1.1, 95% CI [0.5, 2.7], P=0.84), decreased unplanned inpatient encounters (OR 0.8, 95% CI [0.3, 2.2], P=0.73) or increased unplanned outpatient encounters (OR 1.8, 95% CI [0.1, 21.3], P=0.64).

Conclusions: Dedicated rounds more than doubled patient surveillance resulting in lower-acuity encounters and decreased invasive / higher-acuity bedside interventions.