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

• DOI: 10.1038/s41372-024-02034-x
• Publication Date: 2024-06-24T13:02:47Z
• Authors: Joana Silva Machry; Julia Krzyzewski; Courtney Ward; Gretchen Thompson; Deanna Green; Aaron Germain; Caren Smith; Beatriz Teppa; Amy Ashburn; Allison Fernandez; John Morrison; Nicholas Jabre; Kathy Renn; Fauzia Shakeel; Danilo Escoto; Dina Ashour; Jamie L. Fierstein; Misti Moore; Grace Freire; Angela Green
• Keywords: Multidisciplinary team; Tracheitis

Evaluate feasibility and impact of "Tracheostomy Team" on survival and length of stay (LOS) at a level IV NICU.Plan-do-study-act cycles targeted five Global Tracheostomy Collaborative "key drivers". From January 2017 to December 2022 multidisciplinary, bimonthly bedside rounds were conducted.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.Multidisciplinary approach is feasible, resulting in improved survival without a sustained increase in LOS. Future QI efforts should address post-operative infectious complications.