Quantifying the benefits from a care coordination program for tracheostomy placement in neonates.

OBJECTIVE: Value-based care models are becoming instrumental in structuring clinical care delivery in our healthcare climate. Our objective was to determine the value associated with implementation of a Family-Centered Care Coordination (FCCC) program for neonates undergoing tracheostomy. METHODS: A multi-disciplinary FCCC program was implemented at the Massachusetts Eye and Ear Infirmary and MassGeneral Hospital for Children in January 2013. This program is designed to ensure a safe transition out of the hospital for children undergoing tracheostomy, reduce re-admission rates, and increase caregiver quality of life (QOL). Study participants included neonates undergoing tracheostomy in 2012 and 2015. This retrospective cohort study examined length of stay (LOS), utilized time-driven activity-based costing to estimate the cost of care, assessed caregiver QOL with 1-month Pediatric Tracheostomy Health Status Instrument (PTHSI) scores, and assessed complications with 6-month Medical Complications Associated with Pediatric Tracheostomy (MCAT) scores. RESULTS: Following implementation of the FCCC program, average LOS decreased from 30.5 days (range 17-39) to 16.6 days (range 9-23). The largest process improvement (cost reduction of 61%) occurred in the discharge-planning phase. The overall cost per care cycle was reduced by 36%. A large clinically meaningful benefit was demonstrated for PTHSI (effect size 0.80) as well as MCAT scores (effect size 9.35). CONCLUSIONS: We demonstrated the higher outcomes, including reductions in caregiver burden and complication rates, and the lower costs associated with implementation of the FCCC program for neonates undergoing tracheostomy.

Understanding the challenges during transitions of care for children with critical airway conditions.

PURPOSE: The specific aim of this qualitative descriptive study was to gain an understanding of the challenges occurring during transitions of care between two institutions for children with critical airway conditions. METHODS: Qualitative descriptive methodology was utilized to analyze data from two focus groups conducted with nurses from two adjacent institutions. RESULTS: The focus groups were composed of 19 staff nurses, three case managers, one clinical nurse specialist and two nurse directors. Three themes emerged from the nurses' focus groups: Uncertainty with Diagnosis, Communication Between Healthcare Facilities and Family Members, and Parental Acceptance/Readiness to Learn. CONCLUSION: Nurses are in a unique position to improve both the quality and coordination of care to these children and their family members. An effort to improve transfer of care between institutions and nurses could reduce the combined length of stay for patients and reduce avoidable readmissions. Nurses are in a key position to enhance the competence, confidence, and comfort for family members and caretakers to exercise their post-discharge responsibilities. IMPLICATIONS FOR PRACTICE: Consistent, clear communication among health care providers and family members can improve care in this vulnerable population. These data identified need for further education of nurses.