The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients

期刊论文
发表日期：

2024年6月24日

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Joana Silva Machry,
Julia Krzyzewski,
Courtney Ward,
Gretchen Thompson,
Deanna Green,
Aaron Germain,
Caren Smith,
Beatriz Teppa,
Amy Ashburn,
Allison Fernandez,
John Morrison,
Nicholas Jabre,
Kathy Renn,
Fauzia Shakeel,
Danilo Escoto,
Dina Ashour,
Jamie L. Fierstein,
Misti Moore,
Grace Freire,
Angela Green

摘要

Objective

Evaluate feasibility and impact of “Tracheostomy Team” on survival and length of stay (LOS) at a level IV NICU.

Methods

Plan-do-study-act cycles targeted five Global Tracheostomy Collaborative “key drivers”. From January 2017 to December 2022 multidisciplinary, bimonthly bedside rounds were conducted.

Results

After 3 cycles, in-hospital survival among 39 patients with tracheostomy improved and sustained from 67% to 100% (baseline 18/27; 66.7%; QI 35/39, 89.7%; p = 0.03). Median LOS (days [IQR]) did not significantly differ between baseline and QI (237 [57–308] vs. 217 [130–311]; p = 0.9). Among patients with BPD, median LOS was higher after QI interventions (baseline 248 [222–308] vs. QI 332.5 [283.5–392]; p = .02). Special cause variation resulted from peak increase in LOS during the COVID19 pandemic (2021). Tracheitis/pneumonia was treated significantly more frequently in QI BPD patients.

Conclusion

Multidisciplinary approach is feasible, resulting in improved survival without a sustained increase in LOS. Future QI efforts should address post-operative infectious complications.