O2098: From Hospital to Home – Increasing Caregiver Confidence and Skills in Order to Safely Manage Tracheostomy Emergencies with High Fidelity Simulation

Background: An increasing percentage of children are requiring tracheostomy placement for critical airway support and long-term mechanical ventilation. The complex care team at our tertiary institution has developed a standardized program for families to ensure they have the necessary skills to care for their child with a tracheostomy at home following discharge. Few studies describing the use of a simulation-based discharge program for caregivers of children with tracheostomies have shown improvements in self-reported confidence and performance of tracheostomy care skills, including CPR and basic ventilator troubleshooting. The purpose of this study is to determine if the addition of tracheostomy emergency scenarios using a high-fidelity mannequin to our existing program increases caregiver confidence in their skills prior to discharge within a safe and positive learning environment.

Methods: Caregivers of hospitalized children up to 18 years old, currently located in the PICU, CVICU, or NICU, and preparing for discharge to home, are eligible for enrollment. This study utilizes a prospective and descriptive pre- and post-interventional design, with the inclusion of qualitative feedback. We developed four different simulation scenarios that replicate the most common tracheostomy emergencies. Caregivers participate in two sessions and complete one pre- and two post-session self-evaluation surveys that utilize a 5-point Likert Scale. Our study received full IRB approval on July 31, 2024. Our goal is to have at least 20 caregivers enrolled by the time of journal publication in 2026, with full analysis of pre- and post-surveys.

Results: 17 caregivers have participated in our study since full IRB approval in July of 2024. Preliminary survey findings demonstrated significant improvement in caregivers' preparedness and confidence after simulation training for managing their child's tracheostomy at home. The percentage of caregivers who "strongly agree" with feeling prepared increased from 35% to 80%, while those "strongly disagreeing" with feeling anxious and worried about taking their child home improved from 10% to 35% of caregivers. Qualitative feedback highlighted the value of hands-on training and reduced stress during practice scenarios.

Conclusion: Our findings highlight the effectiveness of integrating high-fidelity tracheostomy emergency simulations into pre-existing caregiver training programs. This approach significantly enhances caregiver confidence and preparedness while reducing anxiety in managing their child’s tracheostomy at home. These results underscore the value of simulation-based learning in fostering a safe, supportive environment for skill development and emotional reassurance, ultimately improving the transition from hospital to home care for families.