Search

Aim: It is important for nurses to learn sufficient knowledge and skills about tracheostomy care during their undergraduate education. The study was conducted to determine the effect of pediatric tracheostomy care online course on nursing students' knowledge levels and attitudes regarding their role as caregivers. Material and Method: The study was conducted between February and June 2020 at the faculty of health sciences at a state university in Turkey. A total of 76 third-year nursing students registered in the course of Child Health and Diseases Nursing were included in the study. The data were collected with a descriptive features form, a tracheostomy care knowledge test, an attitude scale regarding nurses' caregiver roles. Students were sent online pretest. After pretesting, students were assigned to experimental group (n=37) and control group (n=39) by randomization. The students in the experimental group were given pediatric tracheostomy online course on certain days using the distance education system of the university. After the course, all students in the groups were sent online post-test. The data were analyzed using t test and Chi-square test. Significance was assessed at the level of p

Assessment of caregiver knowledge is an essential part of home healthcare education for pediatric tracheostomy care, however, there is a paucity of evidence in long term. This study aims to determine how caregiver knowledge and misconceptions, as assessed by our knowledge test, changed over a 12-month period following our educational program and whether the test score was associated with any demographics of the caregivers and children with tracheostomy. A prospective cohort study was undertaken to evaluate the knowledge at 3 timepoints after tracheostomy education: baseline (T1), 6 months (T2), and 12 months (T3). Test scores were analyzed for trend and relationship with demographics. Items for which less than 80% caregivers gave correct responses at T1 were considered common misconceptions. Fifty-four caregivers were enrolled. Out of a maximum score of 25, the median (IQR) scores were 22 (21-23), 23 (22-24), and 23 (22-25), at T1, T2, and T3, respectively. The scores at T2 and T3 were significantly higher than at T1 ( P ≤ .01). One common misconception “how to manage when suction got less secretion than expected” was found at all timepoints. Caregivers of children with >2 comorbidities scored slightly higher than those of children with 0 to 2 comorbidities ( P = .01). In conclusion, our caregivers achieved high knowledge scores which increased over the 12-month study period potentially because of repeated assessment and practical experience. Common misconceptions and a factor associated with the knowledge were also identified. These advantages highlighted the importance of knowledge assessment for quality improvement.

Infants and children with medically complex needs depend on their caregivers for activities of daily life and specialized care of various devices they need to survive. Caregiver education is a primary goal in discharge planning to ensure safe, competent home care for these medically fragile children. Standard of care is bedside teaching. The Family Tracheostomy Program complements traditional training with a phased process of simulation. The purpose of this QA/QI project was to increase caregiver competency and decrease anxiety level for pediatric tracheostomy care through simulation training.For two years, the pediatric and neonatal intensive care units trained twenty caregivers of new tracheostomy patients with the supplementation of simulation to standard bedside training. Using a five-point rating scale, caregivers completed pre- and post- tests for separate skills and scenario training sessions.Skills scores were hypothesized to increase after simulation training. In a small sample (n = 20), scores increased from pre-test (μ = 11.45, SD = 4.88) to post-test (μ = 22.6, SD = 2.01). This change was significant (t(19) = 10.78, p0.001). Scenario scores were hypothesized to increase after simulation training. In another small sample (n = 15), scores increased from pre-test (μ = 23.40, SD = 7.11) to post-test (μ = 28.73, SD = 2.31). This change was significant (t(14) = 3.78, p0.001).Simulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples.Organizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.

INTRODUCTION The purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer. METHODS Three tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members. RESULTS Intraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%. CONCLUSIONS We developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.

Objective To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. Methods Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed. Results A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children. Conclusions There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

Objetivo: Descrever a experiência com as orientações educativas de alta hospitalar sob a perspectiva de uma enfermeira inserida no modelo Primary Nursing. Método: Relato desenvolvido a partir da vivência profissional em uma clí­nica médica de unidade hospitalar em São Luí­s, Maranhão, de janeiro a dezembro de 2020. As orientações educativas de enfermagem ocorriam através de treinamentos com os cuidadores e familiares dos pacientes, previamente í alta. Resultados: As informações eram repassadas de forma dialogada, priorizando o familiar e/ou cuidador que seria mais presente no domicí­lio, enfatizando orientações educativas de enfermagem relacionadas aos cuidados gerais com a pele, cuidados com a traqueostomia, gastrostomia ou jejunostomia, administração de dieta enteral e de medicamentos. Conclusão: O planejamento das orientações educativas na alta hospitalar são atribuições importantes do enfermeiro primário, promovendo a continuidade do cuidado e segurança por parte dos cuidadores em realizar assistência aos pacientes neurosequelados no ambiente domiciliar.

To evaluate the problems in doing emergency tracheostomy and tracheostomy care of patients with unknown COVID-19 status. Study the usefulness of the specially designed Tracheostomy Shield. A prospective hospital-based study was conducted at a tertiary care center in India treating COVID and Non COVID patients. The study was done from April 2020 to December 2020. A total of 80 tracheostomy were done using Tracheostomy shield. Open tracheostomies were 38 while 42 patients were already intubated (closed circuit). The Tracheostomy shield was also used in 380 tracheostomy tubes changes. Two patients were found COVID positive on RT-PCR after tracheostomy. There was no scope for testing all tube changes with RT-PCR. The use of our indigenously designed Tracheostomy shield has been effective in reducing the aerosol spread and there was no COVID transmission reported. The use of patient Tracheostomy shield is of uttermost importance in reducing the respiratory droplets splashing on to the surgeon and assistant while doing awake tracheostomy. It is extremely useful while changing tubes as there are chances of false negatives antigen test which might be miss leading. The use of Tracheostomy shield is very important in the current context of new and fast evolving respiratory infections.

Introduction: Tracheostomy tube care in a pediatric age group is challenging. The systematic approach for tracheostomy care and guidance to the care giver and parents will reduce complications related to tracheostomy. The purpose of this article is to ensure the safety of the infants and children who have tracheostomy tube placed in the neck. Materials and Methods: The acronym (tracheostomy) was created to teach and train the care giver and nursing staff for better post tracheostomy care. All the aspects of tracheostomy care have been included in this as mentioned below Tube change-when to change? Regular cleaning-how to perform? Airway protection-what is required? Complication awareness-how to prevent? Home kit requirement-things to keep ready bedside. Emergency situations-when to call your doctor? Oral hygiene- why it is important? Stoma/skin care-what to look for? Ties care-too tight or too loose? Outer & inner tube cleaning-how to perform? Mucous problems-suctioning tips Your safety-what all you must know. Results: The acronym is easy to remember and easy to follow. Conclusion: A systematic tracheostomy care approach can give better outcomes and reduced complication rate in pediatric age group. It will be benefitted for all the health care professionals, nursing staff and the care givers involved with the children who need tracheostomy care. Keywords: tracheostomy post tracheostomy care.

OBJECTIVES/HYPOTHESIS To investigate the effect of a multimedia educational module on provider attitudes toward pediatric tracheostomy care. We also describe the process of module development and dissemination at an academic children's hospital. STUDY DESIGN Prospective observational study. METHODS The pediatric airway committee at an urban tertiary care center developed a multimedia pediatric tracheostomy care module. Nurses, respiratory therapists, as well as resident, fellow, and attending physicians caring for pediatric patients with tracheostomies were eligible. Managers and clinical supervisors from various units recruited participants to complete the pediatric tracheostomy care electronic module and pre- and postassessment knowledge quizzes and surveys. Provider confidence was analyzed using Kruskal-Wallis H-test and Mann-Whitney U-test, and paired t-test was used to compare pre- and postmodule quiz scores. RESULTS A total of 422 participants completed the module. A total of 275 participants completed the premodule survey, 385 completed the premodule quiz, 253 completed the postmodule survey, and 233 completed the postmodule quiz. Participants included providers in the neonatal intensive care unit, pediatric intensive care unit, pediatric emergency department, and pediatric wards. Postmodule surveys demonstrated a significant reduction in the average percentage of participants indicating lack of confidence with regards to changing an established tracheostomy, responding to accidental decannulation of established tracheostomy, and responding to accidental decannulation of fresh tracheostomy (P

Risks of pediatric tracheostomy are well known. The objectives of this quality improvement study were to organize tracheostomy supplies into a comprehensive care kit and demonstrate that the kits improved nursing and parental comfort in providing tracheostomy care routinely and emergently. Kits were assembled using roll-up toiletry style bags and organized in a uniform fashion with necessary supplies. Nurses and parents were surveyed using a 5-point Likert-type. Feedback was overall very positive; the kits were found to ease the transition of caring for a child with a new tracheostomy from hospital to home. This intervention can easily be adapted at other pediatric institutions.

Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management. Resumo Introdução: A traqueostomia é um procedimento cirúrgico comumente feito na prática otorrinolaringológica. O cuidado pós-operatório é o aspecto mais importante para alcançar bons resultados para o paciente. A indisponibilidade de diretrizes padrão para o manejo da traqueostomia e o treinamento inadequado podem tornar complexa essa prática básica. A equipe de enfermagem e os médicos desempenham um papel muito importante no manejo à beira do leito, tanto na enfermaria quanto na unidade de terapia intensiva (UTI). Portanto, é crucial que todos os profissionais de saúde diretamente envolvidos na prestação de cuidados pós-operatórios a esses pacientes possam fazer isso de forma eficiente. Objetivo: Avaliar o conhecimento sobre a identificação e manejo de emergências relacionadas à traqueostomia e complicações precoces entre os profissionais de saúde, a fim de melhorar a prática e sua padronização. Método: Estudo observacional transversal que incluiu 254 médicos e enfermeiras de quatro grandes hospitais terciários. As perguntas foram simples e diretas em relação à aspiração da traqueostomia, cuidados com o cuff, manejo do cuff, obstrução da cânula e manejo da alimentação em pacientes traqueostomizados. Resultado: Com base nas evidências de nosso estudo, o nível de conhecimento sobre os cuidados com a traqueostomia varia de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios. Existem lacunas significativas no conhecimento em vários aspectos dos cuidados e manejo da traqueostomia entre os profissionais de saúde. Conclusão: Nossos achados demonstraram um nível de conhecimento adequado entre os profissionais de saúde, variação de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios e revelaram que ainda existem lacunas no conhecimento em vários aspectos do tratamento e manejo do paciente traqueostomizado.

Purpose of review The aim of this review is to provide an update on the management of pediatric tracheostomies. Recent findings Recent literature has focused on optimization of care for children with tracheostomies including prevention and management of skin breakdown, timing of tracheostomy tube changes, the role of multidisciplinary and team-based approaches to education and management of tracheostomy patients, ideal timing of surveillance endoscopy, and the emerging role of telemedicine in the care of tracheostomy patients. Summary A focus on quality improvement and a systematic, team-based approach to care has the potential to improve the quality of care for pediatric tracheostomy patients.

Background Increasing numbers of children with complex health‐care needs are cared for at home by their family. The aim of this qualitative study was to explore the challenges experienced by families caring for children who need complex medical care at home. Methods We conducted a thematic analysis of eleven in‐depth interviews with parents who carry out specialist medical procedures (eg, enteral feeding, bowel washouts and tracheostomy care) for their children at home. Participants were purposely selected from an existing sample of interviews with parents whose child had abdominal surgery in the first year of life. Results We identified three overarching themes: (a) responsibilities of the parent, (b) impact on daily life and (c) the parent journey over time. Parents have substantial responsibilities, including performing medical procedures, managing emergencies (sometimes life‐threatening), co‐ordinating care and advocating for their child. Their responsibilities have an enormous impact on the family: going out of the home becomes a challenge, there are constant constraints on time, parents are sleep‐deprived and there are wider impacts on siblings. The third theme explores the parent journey over time as parents become experts and make sense of the new normal. Discussion The burden of care on families caring for children with complex medical needs is much greater than is generally understood by either multidisciplinary health‐care teams or the general public. Families need to be better prepared and supported for the responsibilities they take on and the burden of care needs to be shared by others.

To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes.The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117).Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement.Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance.A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months.Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points.In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment.In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.

Traheotomija je kirurški postupak kojim se radi otvor traheostoma na prednjoj stjenci dušnika. Po tehnici izvođenja razlikujemo klasičnu traheotomiju, konikotomiju i perkutanu dilatacijsku traheotomiju. Odabir tehnike izvođenja traheotomije ovisi o indikaciji i o stanju bolesnika. Traheostoma može biti privremena ili trajna. Privremena traheostoma se spontano zatvara nakon prestanka njene indikacije, dok se trajna traheostomija izvodi kod bolesnika kojima je učinjena totalna laringektomija. Traheotomija je danas rutinska operacija, međutim brojne su postoperativne komplikacije koje se mogu javiti kod traheotomiranih bolesnika. Postoperativne komplikacije dijelimo na rane i kasne, ovisno o vremenu kad se manifestiraju. Uloga medicinske sestre/tehničara u postoperativnom periodu je da provodi pravilnu njegu traheotomiranih bolesnika, prati vitalne funkcije i promatra izgled i stanje bolesnika. Medicinska sestra/medicinski tehničar provodi njegu i previjanje traheostome, aspirira dišni put, redovito čistiti i mijenja unutarnji uložak kanile, vlaži dišni put, provodi njegu usne šupljine i hrani bolesnika. Praćenjem vitalnih parametara i promatranjem bolesnika, medicinske sestre/tehničari prepoznaju rane simptome komplikacija u postoperativnom periodu. Tim postupcima medicinska sestra/tehničar prevenira komplikacije, rano prepoznaje pojavu komplikacija te omogućuju optimalne uvjete za oporavak bolesnika. Uz postoperativnu njegu medicinska sestra/medicinski tehničar sudjeluje u edukaciji bolesnika o pravilnoj njezi stome, a kao član multidisciplinarnog tima sudjeluje u edukaciji o načinu korištenja govornih pomagala, kao što su govorne kanile, govorni aparat i govorna proteza. Tracheotomy is surgical procedure used to make an opening tracheostoma on the anterior wall of the trachea. According to the technique of performance, we distinguish classical tracheotomy, conicotomy and percutaneous dilatation tracheotomy. The choice of the tracheotomy technique depends on the indication and the patient's condition. Tracheostoma may be temporary or permanent. Temporary tracheostoma is closed spontaneously after the termination of its indication, while it is permanently done in patients with total laryngectomy. Tracheotomy is a very safe operation nowadays, but there are many post-operative complications that can occur in tracheotomised patients. Complications are divided into early post-operative and late post-operative depending on the time they occur. The role of the nurse/technician in the post-operative period is to provide proper care for tracheotomised patients, monitor vital functions and observe the appearance and condition of the patient. The nurse/medical technician carries out tracheostasis curing and wrapping, aspires the airway, regularly cleaning and changing the internal cannula cartridge, wetting the airway, caring the oral cavity and feeding the patient. Monitoring vital parameters and looking at the patient's appearance, nurses/technicians recognise early symptoms of post-operative complications. With these procedures, the nurse/technician prevents complications, early recognizes the occurrence of complications and provides optimal conditions for the patient's recovery. In addition to post-operative care, the nurse/medical technician participates in the education of the patient about self-sufficiency, as a member of a multidisciplinary team participates in education on the use of speech aids, such as voice canals, voice apparatus and voice prosthesis.

Background Pediatric patients require tracheostomy tube placement as a last resort for critical airway management. Around-the-clock care is needed at discharge because of the high risk of morbidity and mortality associated with a tracheostomy. The potential for catastrophic sequalae can create a high stress home environment. A simulation program that used a high-fidelity manikin was implemented to reduce complications, morbidity and mortality, and improve skills for real-life medical scenarios. Methods A tracheostomy care simulation program was implemented at a large tertiary care children's hospital from October 2019 to October 2020. Caregivers participated in a pre-post program survey and rated 9 statements on a 5-point scale with regard to knowledge, confidence, and comfort level of taking care of their child at home. Emergency scenarios included accidental tracheostomy tube dislodgement, tracheostomy tube plugging, cardiac arrest, and ventilator failure. Classes were recorded for objective start-to-finish scenario time stamps and prompt rates. A medical chart review was performed 90 d after discharge. Results Eighteen caregivers for 10 children participated. For the 10 children, there was a 9.1% increase in the average total score agreement from pre to post survey, with scores going from "agree" to "strongly agree" (P = .001). Each subset of questions had a significant increase in scores after participation: knowledge, P = .002; confidence, P = .006; and comfort, P = .01. The caregivers required an average 20% prompt rate for the next step in the scenario. Children were 70% female, 80% white, and 60% had public insurance and had their tracheostomy tube placed at a median age of 4 months (range, 0 months to 24 years). Three children (n = 3/9 [33.3%]) were readmitted for tracheitis within 90 d after being discharged to home. Conclusions Caregiver knowledge, confidence, and comfort levels were increased after participation. Pediatric patients with a tracheostomy are medically fragile, therefore, it is important for caregivers to be aware of and prepared for common tracheostomy emergencies and to "experience" emergency situations firsthand.

Introduction:The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT).Methods:Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed.Results:Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult.Conclusion:In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

Introduction: At the height of the COVID-19 pandemic, our institution instituted a safe tracheostomy aftercare taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to quantify and understand this team's benefits on the outcomes of tracheostomy care. Method: Retrospective data were collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, and was compared with prospectively collected data from tracheostomies performed from February to June 2020 while the STAT team was in place. The primary endpoint was decannulation before discharge. Secondary endpoints included downsizing and outpatient follow-up. Results: Prior to the STAT team, 92 patients underwent tracheostomy from February to June 2019, including 59 males (64%) and 33 females (36%). Following implementation of the STAT team, 170 patients underwent tracheostomy from February to June 2020, including 106 males (62%) and 64 females (38%). Mean time from tracheostomy to discharge was 43.7 days (range, 1-174;standard deviation [SD] 45.5) in 2019 and 39.7 days (range, 2-205;SD 30.3) in 2020. Twenty (22%) and 26 patients (15%) expired in the 2019 and 2020 cohorts, respectively. Of the surviving patients, 22% of patients in 2019 compared with 60% of patients in 2020 were decannulated before discharge (P < .00001). With the STAT team, decannulation rates before discharge increased absolutely by 40% and relatively by 178%. In the 2020 cohort, 59% of patients had documented downsizes during admission compared with just 20% of patients in 2019 (P < .0001). In 2020 the STAT team remained in contact to advise further tracheostomy care for 86% of discharged patients. Conclusion: The STAT team significantly increased decannulation rates, documentation of downsizing, and improved follow-up for tracheostomy care. It is possible that the STAT team's positive impact was related to improved documentation of significant tracheostomy care events. Nevertheless, this type of care team provides significant benefit to hospitals and improves the overall care of patients with tracheostomies.

Background Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). Objective Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. Materials and Methods Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. Results A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). Conclusion Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.

Importance During respiratory disease outbreaks such as the COVID-19 pandemic, aerosol-generating procedures, including tracheostomy, are associated with the risk of viral transmission to health care workers. Objective To quantify particle aerosolization during tracheostomy surgery and tracheostomy care and to evaluate interventions that minimize the risk of viral particle exposure. Design, setting, and participants This comparative effectiveness study was conducted from August 2020 to January 2021 at a tertiary care academic institution. Aerosol generation was measured in real time with an optical particle counter during simulated (manikin) tracheostomy surgical and clinical conditions, including cough, airway nebulization, open suctioning, and electrocautery. Aerosol sampling was also performed during in vivo swine tracheostomy procedures (n = 4), with or without electrocautery. Fluorescent dye was used to visualize cough spread onto the surgical field during swine tracheostomy. Finally, 6 tracheostomy coverings were compared with no tracheostomy covering to quantify reduction in particle aerosolization. Main outcomes and measures Respirable aerosolized particle concentration. Results Cough, airway humidification, open suctioning, and electrocautery produced aerosol particles substantially above baseline. Compared with uncovered tracheostomy, decreased aerosolization was found with the use of tracheostomy coverings, including a cotton mask (73.8% [(95% CI, 63.0%-84.5%]; d = 3.8), polyester gaiter 79.5% [95% CI, 68.7%-90.3%]; d = 7.2), humidification mask (82.8% [95% CI, 72.0%-93.7%]; d = 8.6), heat moisture exchanger (HME) (91.0% [95% CI, 80.2%-101.7%]; d = 19.0), and surgical mask (89.9% [95% CI, 79.3%-100.6%]; d = 12.8). Simultaneous use of a surgical mask and HME decreased the particle concentration compared with either the HME (95% CI, 1.6%-12.3%; Cohen d = 1.2) or surgical mask (95% CI, 2.7%-13.2%; d = 1.9) used independently. Procedures performed with electrocautery increased total aerosolized particles by 1500 particles/m3 per 5-second interval (95% CI, 1380-1610 particles/m3 per 5-second interval; d = 1.8). Conclusions and relevance The findings of this laboratory and animal comparative effectiveness study indicate that tracheostomy surgery and tracheostomy care are associated with significant aerosol generation, putting health care workers at risk for viral transmission of airborne diseases. Combined HME and surgical mask coverage of the tracheostomy was associated with decreased aerosolization, thereby reducing the risk of viral transmission to health care workers.