Medical Student University of Michigan Medical School Ann Arbor, Michigan, United States
Background: Tracheostomy and prolonged mechanical ventilation are increasingly performed for infants and children with a variety of diagnoses. Shared decision-making (SDM) is indicated when prognosis is uncertain and quality of life is paramount. Previous studies have identified multiple areas for improved processes surrounding counseling and SDM for tracheostomy. Prior to launching interventions aimed to improve decision support, we embarked on this chart review project to determine current practices related to tracheostomies in neonatal and pediatric patients. Objective: We aimed to develop a better understanding of SDM as it relates to tracheostomy in pediatrics, through a retrospective chart review to evaluate documentation of family meetings prior to a tracheostomy decision and the content of these meetings. Design/Methods: In this IRB approved retrospective chart review at a single academic center, patients were identified through a medical record search of patients considered for tracheostomy in the pediatric or neonatal ICUs between January 2019 and December 2021. Patients under age 18 and English-speaking were included. Patients were excluded in cases where SDM was not appropriate.
Four team members divided and analyzed these charts using the software program EMERSE to locate medical record notes containing search terms. We identified the primary indication for tracheostomy and related diagnoses.
We aim to analyze associations between decisions (tracheostomy/no tracheostomy) with meeting occurrence (formal/bedside; yes/no), types of participants (family/medical team members), and outcomes (tracheostomy/no tracheostomy; living/deceased) using Chi-square test. We will conduct thematic analysis to see if meeting content, including documentation of topics important in SDM, differ by tracheostomy decisions. We reviewed 51% of the 145 charts included in our analysis and aim to complete the review by March 2024.
