Sim-Based Home Tracheostomy Care: A Mixed Methods Study on Outcomes and Parental Preparedness

Abstract

OBJECTIVES To assess effects of a Simulation-Based Discharge Education Program (SDP) on long-term caregiver-reported satisfaction and to compare clinical outcomes for children with new tracheostomies whose caregivers completed SDP versus controls. METHODS The study employed a mixed methods approach: (1) a qualitative analysis of feedback from caregivers who previously completed SDP, and (2) a quantitative retrospective case-control study comparing outcomes between children with new tracheostomies whose caregivers completed SDP versus controls, matched on discharge disposition and age. The primary outcome was emergency department visits for tracheostomy-related issues within 1 year of discharge. RESULTS Feedback from 18 interviews was coded into 5 themes: knowledge acquisition, active learning, comfort and preparedness, home application of skills, and overall assessment. Caregivers of 27 children (median age 26 months [interquartile range (IQR) 5.5 months–11 years]) underwent SDP training. Clinical outcomes of these children were compared with 27 matched children in the non-SDP group (median age 16 months [IQR 3.5 months–10 years]). There was no significant difference in ED visits for tracheostomy-related complications within 1 year of discharge between the SDP group and non-SDP group (2 [IQR 0–2] vs 1 [IQR 0–2], P = .2). CONCLUSIONS Caregivers reported overwhelmingly positive experiences with SDP that persisted even 4 years after training. Caregiver participation in SDP did not yield a significant difference in ED visits within 1 year of discharge for tracheostomy-related complications compared with control counterparts. Future steps will identify more effective methods for comparing and analyzing clinical outcomes to further validate impacts of simulation-based programs.