PEAK‐II Trach: A Multi‐Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness
Olivia Dunne, Amanda Shen, Roxanna Mosavian, Jonathan Biel, Marc‐Mina Tawfik, Elliot B. Schiff, Alanna M. Windsor, Jacqueline Weingarten‐Arams, Sara Soshnick, Monirah Albathi Mbbs, Meredith Lind, Emily Ernest, Timothy Pian, Tensing Maa, Adam Van Horn, Ilana Harwayne‐Gidansky, Regine Fortunov, Akira Nishisaki, Lesa Ward, James Beal, Kamal Abulebda, Todd Chang, Takunori Hozumi, Ankona Ghosh, Pooja Nawathe, Adrian D. Zurca, Kristin Van Genderen, Lindsay R. Koressel, Biva Narsing, Daniel C. Chiou, Ariel Sugarman, Tarif A. Choudhury, Melissa Fazzari, David W. Lounsbury, Ahsan S. Ahmed, Christina J. YangAbstract
Objective
Pediatric tracheostomy emergencies are high‐acuity events requiring rapid, coordinated team‐based care. This study assessed objective team performance and used in situ simulation to identify systems factors, including latent safety threats (LSTs) and resilience supports, that influence pediatric tracheostomy emergency readiness across diverse clinical settings.
Methods
In situ simulations of pediatric tracheostomy emergencies (obstructed or partially dislodged tubes) were conducted across inpatient floors, critical care units, and emergency departments at 11 pediatric hospitals. Time to completion of critical actions was recorded using the NeoCHART+™ for PEAK‐II mobile application. Structured debriefs identified LSTs and resilience supports at unit and hospital levels. Multivariable Cox proportional hazards models assessed predictors of time‐critical actions (tube replacement, suction, first effective ventilation) and the percentage of critical actions completed.
Results
Sixty‐seven baseline simulations were conducted across 11 institutions. Seventy‐seven percent of teams replaced an identical tracheostomy tube within 5 minutes (median 188.4 seconds, [IQR 165.3, 204.6]). Teams reported a median of 3.2 LSTs per simulation (IQR 3.0, 4.0). Common LSTs included attempted ventilation through occluded tracheostomy tubes, unclear leadership, ambiguous role definitions, and non‐standardized equipment locations. Teams with a RT and at institutions with a dedicated tracheostomy team performed time‐critical actions faster.
Discussion
In situ simulation revealed LSTs, resilience supports, and performance variability that may influence effective pediatric tracheostomy emergency response at the systems level.
Implications for Practice
Variability identified in systems factors and team performance can guide targeted interventions to improve pediatric tracheostomy emergency preparedness.