Liu Charles, Heffernan Colleen, Saluja Saurabh, Yuan Jennifer, Paine Melody, Oyemwense Naomi, Berry Jay, Roberson David
Harvard Medical School, Boston, Massachusetts Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts.
Department of Ear, Nose, Throat, Head and Neck Surgery, Galway University Hospital, Galway, Ireland.
Otolaryngol Head Neck Surg. 2014 Aug;151(2):232-9. doi: 10.1177/0194599814531731. Epub 2014 Apr 30.
The purpose of this study was to review inpatients undergoing tracheostomies at a tertiary care pediatric hospital in a 24-month period and to identify the indications, comorbidities, hospital course, patient complexity, and predischarge planning for tracheostomy care. The goal was to analyze these factors to highlight potential areas for improvement.
Case series with chart review.
Tertiary care pediatric hospital.
Ninety-five inpatients at Boston Children's Hospital requiring a primary or revision tracheostomy during the 24-month period encompassing 2010 to 2011.
Inpatients undergoing tracheostomy during the study period were identified using 2 different databases: the Boston Children's Hospital Department of Otolaryngology and Communication Enhancement database and institution-specific information from the Child Health Corporation of America's Pediatric Health Information System (PHIS). We extracted the specified metrics from the inpatient charts.
Patients undergoing tracheostomy are complex, with an average of 3.4 comorbidities and 13.6 services involved in their care. The tracheostomy was mentioned in 97.9% of physician and 69.5% of nurse discharge notes, and 42.5% of physician discharge notes contained a plan or appointment for follow-up. Of the patients, 33.7% were discharged home (27.3% of the nonanatomic group and 52.4% of the anatomic group). Overall, 8.4% of tracheostomy patients died before discharge.
The complexity of pediatric tracheostomy patients presents challenges and opportunities for optimizing quality of care for these children. Future directions include the introduction and assessment of multidisciplinary tracheostomy care teams, tracheostomy nurse specialists, and tracheostomy care plans in the pediatric setting.
本研究旨在回顾一家三级儿科医院在24个月期间接受气管切开术的住院患者，确定气管切开术的适应证、合并症、住院过程、患者复杂性以及出院前气管切开护理计划。目标是分析这些因素，以突出潜在的改进领域。
病例系列研究并进行病历回顾。
三级儿科医院。
2010年至2011年这24个月期间，波士顿儿童医院95例需要进行初次或再次气管切开术的住院患者。
通过两个不同的数据库确定研究期间接受气管切开术的住院患者：波士顿儿童医院耳鼻喉科与沟通增强数据库以及美国儿童健康公司儿科健康信息系统（PHIS）的机构特定信息。我们从住院病历中提取了指定的指标。
接受气管切开术的患者情况复杂，平均有3.4种合并症，护理涉及13.6项服务。97.9%的医生出院记录和69.5%的护士出院记录提到了气管切开术，42.5%的医生出院记录包含随访计划或预约。患者中，33.7%出院回家（非解剖组的27.3%和解剖组的52.4%）。总体而言，8.4%的气管切开术患者在出院前死亡。
儿科气管切开术患者的复杂性给优化这些儿童的护理质量带来了挑战和机遇。未来的方向包括在儿科环境中引入和评估多学科气管切开护理团队、气管切开术护士专家以及气管切开护理计划。
