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  • Quality Improvement Article
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The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients

Journal of Perinatology volume 44, pages 1854–1862 (2024)Cite this article

Subjects

Abstract

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.

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Fig. 1: Key driver diagram.
Fig. 2: Control chart for survival to hospital discharge.

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Acknowledgements

The authors would like to thank Drs. Kathleen Wasylik and Dr. Rose Trowbridge (Pediatric Ear Nose and Throat Specialists) for their support and participation in Tracheostomy Team rounds and the Johns Hopkins All Children’s Foundation for financial support to the GTC and provision of patient home equipment not covered by insurance (car seat, double stroller, and emergency tracheostomy bag)

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Authors and Affiliations

  1. Division of Neonatology, Maternal Fetal & Neonatal Institute at Johns Hopkins All Children’s Hospital St. Petersburg, St. Petersburg, FL, USA

    Joana Silva Machry, Julia Krzyzewski, Courtney Ward, Aaron Germain, Caren Smith, Fauzia Shakeel & Danilo Escoto

  2. Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Gretchen Thompson, Deanna Green, Beatriz Teppa, Allison Fernandez, John Morrison, Nicholas Jabre, Kathy Renn, Dina Ashour, Jamie L. Fierstein, Misti Moore & Grace Freire

  3. Phoenix Children’s Hospital, Division of Otolaryngology Head – Neck Surgery, Phoenix, AZ, USA

    Amy Ashburn

  4. VP of Safety and Quality, Johns Hopkins Health System Baltimore, Baltimore, MD, USA

    Angela Green

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  1. Joana Silva Machry
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Contributions

Joana Silva Machry (first author): project inception, design; data acquisition, analysis, interpretation of data, manuscript draft, manuscript review, final approval of submitted manuscript, and responsible for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Julia Krzyzewski: project inception, design; data acquisition, analysis, interpretation of data, manuscript review. Courtney Ward, Gretchen Thompson: project design, data acquisition, manuscript review. Deanna Green, Aaron Germain, Caren Smith, Beatriz Teppa, John Morrison, Nicholas Jabre, Fauzia Shakeel, Danilo Escoto, Angela Green (senior author): manuscript review. Amy Ashburn, Allison Fernandez, Kathy Renn: project design, manuscript review. Dina Ashour, Jamie L Fierstein, Misti Moore, Grace Freire: data analysis, manuscript review.

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Correspondence to Joana Silva Machry.

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Machry, J.S., Krzyzewski, J., Ward, C. et al. The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients. J Perinatol 44, 1854–1862 (2024). https://doi.org/10.1038/s41372-024-02034-x

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