ABSTRACT  

Between 2021 and 2022, 22 children received tracheostomies at UCSF, with an average length of stay (LOS) of ~180 days. Discharge for this population is a complex process, including arranging for medical equipment, home care nursing, and training caregivers, which can all lead to delays in discharge and prolong hospital stays. While it's not always possible to control the lack of medical equipment and nursing, we can have an impact on caregiver training. Children who have undergone a tracheostomy require intensive caregiver education, and despite multidisciplinary team efforts, home caregivers may experience fragmented care and communication during the transition from hospital to home^1,2,3,4. A study found that the second most common cause of discharge delays were due to caregiver training delays, with a median range of discharge 41 days after they were deemed medically stable². Other studies have reported similar findings highlighting the challenges of the transition from actively supporting a critically ill patient to physically providing primary care, which can be emotionally complex and involve a steep learning curve ^3,4,5.  An early caregiver training program has the potential to reduce inpatient LOS and healthcare costs^5,6. The primary aim of this project is to reduce LOS by enacting a high fidelity simulation training program integrated with bedside education for caregivers with the secondary goal of reducing readmission rates and improving caregiver competency.