527 - A Simulation-Based Discharge Education Program (SDP) for Caregivers of Children with Tracheostomies: A Mixed Method Study on Patient Outcomes and Parental Preparedness

Poster Number: 527
Publication Number: 527.228

Charles M. Bergman, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States; Timothy C.. Clapper, Weill Cornell Medicine, New York, NY, United States; Marianne Nellis, Weill Cornell Medicine, Cornell University, New York, NY, United States; Anthony Yuen, -, Brookline, MA, United States; Linda Gerber, Weill Cornell Medicine, New York, NY, United States; Kevin Ching, Weill Cornell Medicine, New York, NY, United States

Background: Children who are technology-dependent, such as those with tracheostomies, account for a disproportionate use of health care resources. We designed and implemented a Simulation-Based Discharge Education Program (SDP) for caregivers of children with tracheostomies and previously reported improvements in caregiver self-reported comfort and tracheostomy care skill performance. However, long term outcomes are unknown.

Objective: To assess the effect of SDP on long-term caregiver-reported satisfaction and to compare clinical outcomes for patients with new tracheostomies whose caregivers completed SDP versus those whose caregivers have not.

Design/Methods: We conducted a mixed method study. A prospective qualitative study was performed to elicit and analyze feedback from caregivers who previously completed SDP within the last 4 years. A retrospective cohort study compared outcomes between patients with new tracheostomies whose caregivers have completed SDP versus those whose caregivers have not participated, matched on disposition upon discharge from the hospital and age. The primary outcome measured was ED visits for tracheostomy-related issues within 1 year of discharge.

Results: Caregiver feedback from 18 interviews was coded into five distinct themes: knowledge acquisition, active learning, comfort and preparedness, home application of skills, and overall assessment of SDP. Caregivers reported that completing SDP helped them feel more confident to care for their dependents at home. Caregivers also recounted numerous instances using SDP training to troubleshoot tracheostomy issues at home. The caregivers of 27 children (median age 26 months [IQR 5.5 months - 11 years]) underwent SDP training. The clinical outcomes of these children were matched and compared to 27 children in the non-SDP cohort (median age 15.5 months [IQR 3.5 months -10 years]). Our retrospective review did not demonstrate a significant difference in ED visits for tracheostomy-related complications within the first year of discharge from the hospital between the SDP-cohort and the non-SDP cohort (2 [IQR 0-2] v 1 [IQR 0-2], p=0.2).

Conclusion(s): Participating caregivers subjectively report overwhelmingly positive experiences with SDP that persist even 4 years following discharge from the hospital. Despite their experience, participation in SDP for caregivers of pediatric patients with new tracheostomies did not yield a significant difference in the incidence of ED visits for tracheostomy-related complications compared to control counterparts. Further studies are warranted to prospectively examine these relationships in larger cohorts.