Improved Tracheostomy-Dependent Patient Outcomes After Implementation of
the Pediatric Resident Education in Pulmonary (PREP) Boot Camp
Abstract
Introduction: Children with tracheostomies are high risk for
morbidity and mortality. Pediatric resident physicians are not routinely
taught skills to care for this vulnerable patient population. Few
reports link educational interventions to improved patient outcomes.
This study evaluates the impact of an intensive educational training
program on pediatric residents’ observed skills and
tracheostomy-dependent patient outcomes. Methods: Pediatric
post-graduate year 2 (PGY2) resident physicians rotating through the
inpatient pediatric pulmonology month at Children’s Hospital Colorado
July 2018-2019 participated in the Pediatric Resident Education in
Pulmonary (PREP) Boot Camp, an intensive educational program with an
interactive lecture and simulation experience on patients with
tracheostomy-dependence. PGY2s who partook in PREP and PGY3s who rotated
prior to PREP initiation were invited to be studied. Primary outcomes
included: 1) resident skills assessed by direct observation during
simulation encounters and 2) rates of intensive care unit (ICU)
transfers in tracheostomy-dependent patients following acute events
before and after introduction of PREP. We hypothesized that increased
education would enhance resident skills and improve patient outcomes by
decreasing the rate of ICU transfers. Results: PGY2 residents
retained skills learned during PREP up to 11 months following initial
participation, and significantly outperformed their PGY3 counterparts.
There was a significant decrease in ICU transfer rate in patients with
tracheostomies admitted to the pulmonary team during the 19 months
following initiation of PREP. Conclusions: Enhanced early
education improves resident physicians’ ability to care for complex
patients with tracheostomies and improves outcomes in this high-risk
population.