Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations

Abstract

Objective: To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps.

Methods: A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments.

Results: The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively.

Conclusions: The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives.

Level of evidence: 5 Laryngoscope, 133:3588-3601, 2023.

Keywords: Delphi Technique; airway management; healthcare quality assessments; patient safety; simulation; tracheostomy.

Fig. 1.

Flowsheet of Methods. *Experts identified from rosters of AAO-HNS, ASPO, IPOG, GTC, and peer nominations. **Feedback from survey comments were incorporated into each subsequent round. ***Each survey was distributed only to those who had engaged with the prior survey.

Fig. 2.

Results of Survey 2: Light-shaded bars represent items below the threshold of “consensus”. List of items in Domains 1 and 2 are reordered according to the y-axis values. Items in Domain 3 were not reordered to maintain the clarity of step-wise maneuvers necessary in this category. *Clear Team Leader achieved consensus in round 3, despite not achieving consensus in round 2.

Fig. 3.

Pediatric Tracheostomy Emergency Readiness Assessment Tool. Items are to be scored with a binary “Yes” or “No” via checks. Each domain’s completed steps should be summed to generate a composite “Sub-Score” for that domain.