Use of a classification of indications for pediatric tracheostomy in quality improvement (QI)

Background: Caring for children with a tracheostomy at home may reduce costs. Prior to tracheostomy, in our institution, children may be cared for in inpatient (IP) wards or PICU. After tracheostomy, initial care occurs in PICU, then in a special section of IP area before transfer home. We initiated QI to improve care and shorten length of stay. We noted current classifications of indications for tracheostomy are based on anatomic/pathological findings, of limited value in QI. Objective: To review indications for tracheostomy and develop a classification system To map a child’s progress using this classification To use this data to identify opportunities for QI Methods: Tracheostomies were created in 100 children from 2005 to 2017, and we summarised the indications thus: Isolated airway anomaly (e.g. subglottic stenosis ), n=51 Complex syndrome with airway anomalies (e.g. Treacher Collins Syndrome) n=21 Tracheostomy to allow invasive ventilation (e.g. neuromuscular disease). N= 28 Results: Time (days) in different parts of our institution Conclusion: Categorization of indication for tracheostomy proved useful in QI. This categorization can be used by others to address service needs and compare programs