PEAK‐II Trach: A Multi‐Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness

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.

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Publication Details

Journal
Otolaryngology
Published
2026-06-29
DOI
https://doi.org/10.1002/ohn.70291
Primary Topic
Simulation-Based Education in Healthcare
Type
article
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article

PEAK‐II Trach: A Multi‐Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness

Melissa J. Fazzari, Monirah Albathi, Tarif A. Choudhury, Biel Jh et al.
Otolaryngology
Simulation-Based Education in Healthcare
article

PEAK‐II Trach: A Multi‐Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness

Melissa J. Fazzari, Monirah Albathi, Tarif A. Choudhury, Biel Jh, Tensing Maa, Biva Narsing, Amanda Shen, Lindsay R. Koressel, Alanna M. Windsor, Ariel Sugarman, Ilana Harwayne‐Gidansky, Adrian Zurca, James Beal, Emily Ernest, Olivia E. Dunne, Pooja Nawathe, Marc‐Mina Tawfik, Kamal Abulebda, Roxanna Mosavian, Kristin Van Genderen, Christina J. Yang, David W. Lounsbury, T Pian, Adam Van Horn, J Weingarten-Arams, Takunori Hozumi, Ankona Ghosh, Todd Chang, Ahsan Ahmed, Regine Fortunov, Lesa Ward, Elliot B. Schiff, Akira Nishisaki, Sara Soshnick, Meredith Lind, Daniel C. Chiou
article en

Abstract

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.

Otolaryngology
Princess Nourah bint Abdulrahman University (SA), Northwestern University (US), Cedars-Sinai Medical Center (US), Albert Einstein College of Medicine (US), Nationwide Children's Hospital (US), Westchester Medical Center (US), Children's Hospital of Philadelphia (US), Children's Hospital of Los Angeles (US), Baylor College of Medicine (US), Cornell University (US), University of Michigan (US), Columbia University Irving Medical Center (US), Riley Hospital for Children (US), NYU Langone Health (US), Children's Hospital Colorado (US), Mount Sinai Hospital (US), Mount Sinai Hospital (US), Children's Hospital at Montefiore (US), Aria - Jefferson Health (US), Indiana University – Purdue University Indianapolis (US), New York University (US), Albany Medical Center Hospital (US), Columbia University (US), University of Pennsylvania (US), Penn State Milton S. Hershey Medical Center (US), Jefferson College (US), University of Colorado Denver (US)
Openalex Percentile: Top 8%
Simulation-Based Education in Healthcare
DOISourceOpenAlex
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