Pediatric patients who have complex respiratory problems, especially children with tracheostomies, face serious challenges in the health care system. Often, they are treated by several specialists, and poor communication among providers can increase the chance that their care will be less than optimal.
[Photo: Ms. Kathy Abode]
In an article published online January 11 in the journal Pediatrics, UNC Gillings School of Global Public Health alumna Ms. Kathleen Abode describes how the North Carolina Children’s Airway Center has tackled many of the challenges to good care by decreasing and optimizing hospitalization, improving communication among providers and avoiding tracheostomy complications by using an interdisciplinary team to initiate targeted improvements in care.
UNC’s Airway Center was established at UNC Children’s Hospital in 2007 to provide an organizational framework for efficient outpatient multidisciplinary care, existing as a “virtual clinic.” Patients move between hospital-based specialty clinics for same-day appointments with designated physicians, while the center’s nonphysician staff meets with patients and caregivers between physician appointments.
The current study tracks the implementation and outcomes of improvement initiatives from the clinic’s inception until 2013. Researchers reviewed records of 1,273 children from birth to age 21 years who had been served over the six-year period.
The proportion of patients with tracheostomies increased from 42 percent in 2007 to 64 percent in 2013. Researchers had three aims – to optimize length of hospital stay for children with newly placed tracheostomies, to improve communication among providers and caregivers, and to avoid tracheostomy complications.
The barriers to timely hospital discharge included lack of teaching tools and staff members to provide training to the children’s caregivers and delay in requesting appropriate medical supply requests for use outside the hospital. To address these challenges, the center enhanced educational strategies, including providing written and audiovisual materials in both English and Spanish, training a wider group of medical personnel who could teach parents and other caregivers, and initiating care planning at the time the decision was made to proceed with tracheostomy. The mean length of hospital stay for tracheostomy patients under one year of age decreased from 37 days in 2007 to 26 days in 2013.