Pediatric Tracheostomy Education Program Structures, Barriers, and Support: A Nationwide Survey of Children's Hospitals.

Objective: Safe discharge for children with tracheostomies requires caregivers to be competent in tracheostomy management, including emergency interventions. Inpatient pediatric units are tasked with preparing families for discharge, yet variations exist in the standards of tracheostomy education across institutions. To address this gap, we aimed to describe the inpatient tracheostomy education programs in children's hospitals across the United States.

Study Design: This is a cross-sectional study conducted between May and July 2022.

Setting: We distributed an online survey to a purposeful sample of representatives from participating children's hospitals.

Methods: The 42-item survey evaluated various aspects of tracheostomy education, including teaching strategies, timing of education, operational support, and overall program structure. Descriptive statistics were generated, and researchers reviewed open-ended items to identify themes.

Results: Thirty-seven institutions participated, 26 of which were free-standing children's hospitals. All programs surveyed conducted bedside checkoffs, required a rooming-in period, and provided tracheostomy cardiopulmonary resuscitation and low-fidelity simulation for emergency teaching. Programs varied in the order of education and the type of support received. Many programs lacked a postdischarge follow-up structure and the majority evaluated program effectiveness with readmission rates. Lack of private-duty nursing was the primary barrier to discharge, followed by family availability and reluctance to participate in education.

Conclusion: The program structure and support variations suggest that more investigation is needed in discharge education and postdischarge follow-up for children with tracheostomies. A national guideline for tracheostomy education and identification of standardized quality metrics for program evaluation would benefit current and emerging programs.