1. 10 Year Review of Paediatric Tracheostomies The Leeds Teaching Hospitals NHS Trust

2. Changing times Changing indications for tracheostomy Fewer short-term tracheostomies Most for chronic problems leading to tracheostomy use for months or years

3. Parental competency in tracheostomy management 2 carers trained Gain competencies in: – Suctioning tube – Changing tapes – Changing tubes – Coping with emergencies Tube obstruction Tube dislodgement – Basic paediatric life support

4. Study Objectives To review indications and length of hospital stay in children undergoing tracheostomy To highlight reasons for prolonged hospitalisation once medically fit Identify impediments to timely discharge

5. Methods 10 year retrospective study 2000 – 2010 All children undergoing tracheostomy in LTH – Mr Knight, Mr Crabbe Identified using theatre database Case notes reviewed

6. Data collected Demographics Indication for tracheostomy Length of hospital stay Reasons for extended stay Destination on discharge Mortality

7. Results 109 children identified 101 notes reviewed – Age range 0-15 years ENT - Mr Knight – 47 Paed Surgery - Mr Crabbe – 45 Other - 9

8. Age distribution No of children

9. Age distribution (<18 months)

10. 40%

11. Indications To facilitate artificial ventilation To relieve upper airway obstruction

12. Indications To facilitate artificial ventilation Weaning from ventilator Needs prolonged ventilation Needs regular pulmonary toilet To relieve upper airway obstruction Bypass blockage or narrowing in upper airway

13. Indications

14. Indications for tracheostomy

21. Indication vs. Age

24. Mortality

26. Time in hospital after tracheostomy Mean 81 daysRange 1 – 603 days

27. Time in hospital after “medically fit” Mean: 19 days Range: 0 – 265 days

28. Time in hospital after “medically fit” Time (days)

29. Time in hospital after “medically fit” Time (days) 56 children delayed

30. Time in hospital after “medically fit” Time (days) 56 children delayed 23% for > 1 month

31. Time in hospital after “medically fit” Time (days) 56 children delayed 23% for > 1 month

32. Less than 2 weeks 2 to 4 weeks 4 to 8 weeks 8 to 12 weeks More than 12 weeks

33. Up to 2 weeks - 20

41. 2 to 4 weeks - 13

47. 4 to 8 weeks - 14

53. 8 to 12 weeks - 4

56. More than 12 weeks 5 children Multiple factors – awaiting changes to housing – 3 – social problems – 3 – tracheostomy training – 1

57. Delays due to…. Equipment provision Changes to home environment Parental tracheostomy training – 22 children Social factors

58. Social & external factors Concerns about parenting ability Parental drug and alcohol abuse Family on “at risk register” Children placed in foster care – 5 children

59. Social & external factors Parental separation / divorce Single parents Effects on employment

60. Social & external factors English not as 1 st language – 18 families – Interpreters required

61. What can we do? Can’t prevent external factors Early enrolment of parents on structured training programme Early involvement of social care organisations Good integration of medical, social and outreach services

62. What can we do? Dedicated paediatric tracheostomy nurse specialist to coordinate the discharge of infants and children with tracheostomies

63. Summary Paediatric tracheostomy may result in: significant impact on both child and family direct and indirect financial burden to both family and health service prolonged hospitalisation delayed discharge due to social factors