Grant Application

Allison Tobey, MD, UPMC Children’s Hospital of Pittsburgh

Proposed Innovation

Pediatric patients who have an airway obstruction or chronic respiratory failure may require a tracheostomy — a tube surgically inserted into the trachea — to assist with breathing. It requires medically complex, around-the-clock care because of the high risk of illness and death. Although caregivers learn about basic care before discharge, they often experience a high degree of stress at home. Phone calls to nursing staff, specialist appointments, emergency department visits, and hospital readmissions related to complications are frequent.

This project aims to reduce the tracheostomy-related stress, complications, hospital readmissions, and death by introducing a realistic pediatric tracheostomy care simulation program using computerized manikins.

Improvements in Action

Both an infant and a child-size manikin will be purchased to simulate real-life scenarios for training family caregivers and health care professionals. The manikins will provide simulated, hands-on practice in basic tracheostomy care and non-emergency complications. In addition, they will offer simulated practice in handling five of the most frequent tracheostomy-related emergencies, including accidental tube removal, ventilator malfunction, and obstructions.

Intended Outcomes

The overall goal of the pediatric tracheostomy simulation program — the first simulation program offered to caregivers by the Winter Institute for Simulation, Education and Research (WISER), part of The Wolff Center at UPMC — is to decrease caregiver anxiety as well as decrease mortality and complication rates for these young patients.

Caregivers will have the opportunity to learn and practice skills before the patient is discharged from the hospital; health professionals will be able to refine their tracheostomy care and decision-making skills. The program is expected to reduce caregiver stress by improving competency, self-efficacy, and comfort level, and reduce the health care burden with fewer nurse phone calls, office visits, emergency department visits, and hospital readmissions. In addition, refresher courses and online resources will provide caregivers the opportunity to assess their skill and knowledge.