title: A Multidisciplinary Children's Airway Center: Impact on the Care of Patients With Tracheostomy.
abstract: BACKGROUND
  Children with complex airway problems see multiple specialists. To improve outcomes and coordinate care, we developed a multidisciplinary Children's Airway Center. For children with tracheostomies, aspects of care targeted for improvement included optimizing initial hospital discharge, promoting effective communication between providers and caregivers, and avoiding tracheostomy complications.
  
  
  METHODS
  The population includes children up to 21 years old with tracheostomies. The airway center team includes providers from pediatric pulmonology, pediatric otolaryngology/head and neck surgery, and pediatric gastroenterology. Improvement initiatives included enhanced educational strategies, weekly care conferences, institutional consensus guidelines and care plans, personalized clinic schedules, and standardized intervals between airway examinations. A patient database allowed for tracking outcomes over time.
  
  
  RESULTS
  We initially identified 173 airway center patients including 123 with tracheostomies. The median number of new patients evaluated by the center team each year was 172. Median hospitalization after tracheostomy decreased from 37 days to 26 days for new tracheostomy patients <1 year old discharged from the hospital. A median of 24 care plans was evaluated at weekly conferences. Consensus protocol adherence increased likelihood of successful decannulation from 68% to 86% of attempts. The median interval of 8 months between airway examinations aligned with published recommendations.
  
  
  CONCLUSIONS
  For children with tracheostomies, our Children's Airway Center met and sustained goals of optimizing hospitalization, promoting communication, and avoiding tracheostomy complications by initiating targeted improvements in a multidisciplinary team setting. A multidisciplinary approach to management of these patients can yield measurable improvements in important outcomes.
authors.affiliation: University of North Carolina Health Care System, Chapel Hill, North Carolina; and Division of Pulmonology, Department of Pediatrics, and jka@med.unc.edu.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Abode
authors.affiliation: Division of Pulmonology, Department of Pediatrics, and Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Amelia F
authors.initials: AF
authors.lastname: Drake
authors.affiliation: Division of Pulmonology, Department of Pediatrics, and Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Zdanski
authors.affiliation: Division of Pulmonology, Department of Pediatrics, and.
authors.forename: George Z
authors.initials: GZ
authors.lastname: Retsch-Bogart
authors.affiliation: Division of Pulmonology, Department of Pediatrics, and.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Gee
authors.affiliation: Division of Pulmonology, Department of Pediatrics, and.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Noah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control; D011368:Professional-Family Relations; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D014139:Tracheostomy; D055815:Young Adult