The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

MULTI DISCIPLINARY APPROACH IN A PEDIATRIC OUTPATIENT TRACHEOSTOMY CLINIC.

Lisa Tyler, BS, RRT-NPS, CPFT, Dan Dawson, RRT-NPS, Michael Duff, RRT-NPS, Department of Respiratory Care Services, Ian Jacobs, MD, Lisa Elden, MD, Teresa Flanagan, RN, CRNP, Anne DeLeo, CRNP, Department of Otorhinolaryngology (ENT), Julie Webb, MA, CCC-SLP, Susan Ferry, RRT, CCRC, Linda Napoli, MS, RRT-NPS, RPFT, The Children's Hospital of Philadelphia, Philadelphia, PA.

Introduction: Patients with tracheostomy or identified with airway issues require complicated medical care even in the outpatient setting. The Children’s Hospital of Philadelphia offers an outpatient clinic incorporating a highly trained and diversified multi-discipline team caring for these special needs patients.

Methods:
In an effort to provide broad scope airway care to a pediatric outpatient, a team consisting of two ENT attendings, three ENT nurse practitioners, a respiratory therapist, and a speech language pathologist, is brought together bi-monthly to do a comprehensive airway evaluation. Most patients are seen every 4 to 6 months based on the severity of the airway complication. Evaluations may include:

  • Flexible laryngoscopy: airway evaluations of vocal cord paralysis, tracheal laryngeal malacia, tracheal stenosis, granulation tissue, secretion pooling
  • Tracheostomy changes: for size, position, and critical airway change
  • Decannulation evaluations: Passey Muir Valve and cap trials
  • OR scheduling: bronchoscopy, T & A, and Nissen
  • Respiratory equipment checks
  • Airway clearance techniques
  • Speech evaluations-gag and swallow studies Care plan for anticipated medical needs are coordinated concurrently. The primary care givers were administered a satisfaction survey. A six-point questionnaire identified airway anomaly, overall satisfaction and benefits, length of clinic attendance, assessment of multidisciplinary approach, and suggestions for improvement. Twenty-three surveys were completed.

    Results:
    Of the 23 respondents, 100% where satisfied with the multi-disciplinary approach of the clinic. The average length of attendance was 3.1 years, with overall attendance ranging from first time visitor to 13 years. The average age of patients attending clinic was 6.4 years, ranging from 4 month to 22 years old.

    Conclusion: There was overall approval from primary care givers. Cited as benefits of airway clinic were: team approach, confidence in the expertise of the staff, familiarity between patient and staff, and meeting with and receiving support from other like caregivers. The long-term benefits and resulting high satisfaction in the team approach to airway care are likely to have sustained the high attendance and the care giver compliance seen in patients for multiple years. Future studies to examine readmission and infection rates in this group are planned.