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. 2024 Dec;44(12):1854-1862.
doi: 10.1038/s41372-024-02034-x. Epub 2024 Jun 24.

The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients

Joana Silva Machry  1 , Julia Krzyzewski  2 , Courtney Ward  2 , Gretchen Thompson  3 , Deanna Green  3 , Aaron Germain  2 , Caren Smith  2 , Beatriz Teppa  3 , Amy Ashburn  4 , Allison Fernandez  3 , John Morrison  3 , Nicholas Jabre  3 , Kathy Renn  3 , Fauzia Shakeel  2 , Danilo Escoto  2 , Dina Ashour  3 , Jamie L Fierstein  3 , Misti Moore  3 , Grace Freire  3 , Angela Green  5
Affiliations

The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients

Joana Silva Machry et al. J Perinatol. 2024 Dec.

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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Conflict of interest statement

Competing interests: The authors declare no competing interests.

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