Abstract
Background:
Training caregivers to care for technology-dependent children after discharge is comprehensive and challenging. In our facility, initial hospital discharge to home of ventilator-dependent children with a tracheostomy requires education of 2 caregivers. Our comprehensive education program (EP) is offered to caregivers of all patients with tracheostomy placement. The EP involves interactive sessions with patient and caregivers to facilitate the knowledge of all aspects of medical care competently and independently (Figure 1). In March of 2020, COVID-19 placed challenges on the EP due to visitor limitations and social distancing guidelines (limited to 1 visitor). We aimed to evaluate the effect of these restrictions on education and discharge of ventilator-dependent children with tracheostomy in our facility.
Methods:
We performed an IRB-approved retrospective data analysis of patients receiving a tracheostomy with caregivers opting for the goal of discharge home from 1/1/2019–12/31/2020. We examined tracheostomy indication, average length of stay (LOS), EP completion time, discharge delays, and visitation policy exemptions granted. Discharge delays were classified as medical or non-medical, with non-medical delays occurring when patients were stable on a home ventilator for ≥7 d.
Results:
In 2019 and 2020, patient age ranged from 3 weeks to 18 years and the most common indication for tracheostomy was bronchopulmonary dysplasia. In 2019, there were 21 patients who received tracheostomy enrolled in our EP. 76.2% (n = 16) were discharged home and 23.8% (n = 5) were discharged to a facility. 76.2% (n = 16) completed the EP. Those who did not complete the EP reported difficulty obtaining a second caregivers or travel difficulties. Total median LOS was 77 d, median EP completion time was 50 d, and median non-medical delay was 42 d. In 2020, there were 19 patients who received tracheostomy enrolled in our EP. 84.2% (n = 16) were discharged home and 15.8% (n = 3) remained admitted. 100% (n = 19) completed the EP. Total median LOS was 79 d, median EP completion time was 48 d, and median non-medical delay was 22 d, not including the 3 patients who remained admitted. Visitor exceptions (to allow 2 caregivers for EP) were granted by administrative leaders 100% of the time. All non-medical delays were secondary to difficulties with obtaining private duty nursing.
Conclusions:
Caregiver training for ventilator-dependent children after tracheostomy placement in our facility was not negatively impacted by COVID-19 visitor restrictions. NMD did not significantly increase from 2019 to 2020. Further studies must be done in order to review the impact of COVID-19 on technology dependent patients more globally.
Table 1 shows the tracheostomy placement and outcomes from 2019 and 2020 in our pediatric facility.
Figure 1 displays the technology dependent EP structure and components. View all access options for this article.Tracheostomy Placement and Outcomes
Year
Total Tracheostomy Patients
Patients Enrolled in EP
Discharged to Home
Discharged to LTCF
Transferred
Expired
Decannulated
Currently Admitted
2019
35
21
16
12
1
3
3
0
2020
32
19
16
8
3
1
0
3
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