90 - Target Based Tracheostomy Care Decreases Variation in Practice and Length of Stay in the PICU
Monday, April 27, 2026
8:00am - 10:00am ET
Publication Number: 4088.90
javier gelvez, Cook Children's Medical Center, Crowley, TX, United States; Brooke MacDonald, Cook Children's Medical Center, Fort Worth, TX, United States; Cameron Larson, Cook Children's Medical Center, Fort Worth, TX, United States; Vinai Modem, TCU Burnett School of Medicine, Fort Worth, TX, United States
Clinical Nurse Leader- PICU Cook Children's Medical Center Fort Worth, Texas, United States
Background: Target based care (TBC) provides specific goals and performance feedback to caregivers helping to reduce practice variation. A previous published study addressing variation in the care post operative cardiac patients demonstrated that TBC reduced variation in length of stay (LOS). At our institution implementing TBC similarly reduced the LOS for postoperative cardiac patients. Building on this success we implemented TBC for post operative tracheostomy patients in the pediatric intensive care unit (PICU). Objective: To minimize variation and standardize the care of postoperative tracheostomy patients by establishing specific time targets aimed at decreasing the time to key clinical milestones. Design/Methods: This single-center quality improvement study was conducted to evaluate the impact of implementing TBC in patients undergoing tracheostomies for chronic ventilation (CV) or airway obstruction (AO). The study period was divided into pre (9/2021 to 3/22024) and post implementation phase (10/2024 to 10/2025). Target times for key clinical milestones in post operative care were established based on pre implementation values. These target times were posted in the patient room as a reminder for the clinical care team. Adherence to TBC was overseen by the implementation team. The two periods were compared using Mann Whitney U test. Results: 76 patients were enrolled in the study, including 37 (31 pre, 6 post) with AO and 39 (28 pre, 11 post) requiring CV. The eligible cohort was 57% male and had a median age of 5.6 years (IQR: 1.2, 10.2). Post TBC implementation AO group showed statistically significant decrease in time to trach change (5.97 vs 4.26, p 0.03) and discharge (61.32 vs 34.59, p 0.02). It also showed a trend towards decrease in time to sedation discontinuation (5.79 vs 2.97, p 0.14) and transfer out of PICU (8.58 vs 6.71, p 0.27) . CV group showed statistically significant decrease in time to sedation discontinuation (5.84 vs 3.46, p 0.01), trach change (5.53 vs 4.98, p 0.03) and transfer out of PICU (10.83 vs 7.01, p 0.0002). No complications were observed as a result TBC implementation.
Conclusion(s): In this single-center study, with implementation of TBC we were able to demonstrate clinically relevant decrease in times to various milestones in post operative tracheostomy care including time to sedation discontinuation, trach change, transfer out of PICU and discharge out of the hospital. Additionally, we were able to decrease practice variation and streamline TBC for post operative tracheostomies.
