Improving Caregiver Confidence and Skills Through High-Fidelity Pediatric Tracheostomy Simulation

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 07

KA

Karen Adkins, MD

University of Oklahoma Health Sciences Center, Oklahoma

Disclosure(s): No relevant financial relationship(s) to disclose.
DG

Dakota Greenwell, DO, MBA

Resident Physician
University of Oklahoma Health Sciences Center, Department of Pediatrics

Disclosure information not submitted.
AP

Amanda Page, MD

Complex Care Pediatrician
University of Oklahoma Health Sciences Center, Department of Pediatrics

Disclosure information not submitted.
TG

Theresa Graif, MD

Assistant Professor of Pediatric Critical Care Medicine
University of Oklahoma Health Sciences Center, Department of Pediatrics

Disclosure information not submitted.
Manzilat Akande, MD, MPH, MS (she/her/hers)

University of Oklahoma Health Sciences Center, Oklahoma

Disclosure information not submitted.
MG

M. Connor Garbe, MPH

Research Biostatistician
University of Oklahoma Health Sciences Center, Department of Pediatrics

Disclosure information not submitted.
SG

Shealynn Garrett, Associates of Science

Respiratory Therapist
Oklahoma Children's Hospital

Disclosure information not submitted.
AS

Amy Sparkman, MD

Assistant Professor of Pediatric Emergency Medicine and Director of Simulation Training
University of Oklahoma Health Sciences Center, Department of Pediatrics

Disclosure information not submitted.
MM

Michael McGrail, CHSOS

Simulation Specialist
University of Oklahoma Health Sciences Center and College of Medicine

Disclosure information not submitted.

Introduction: Children with tracheostomies, especially those who are ventilator dependent, require extensive caregiver education before discharge. Standardized teaching may not fully prepare caregivers for high-stress emergencies at home. High-fidelity simulation has demonstrated value in clinical training, but its application in caregiver education for pediatric tracheostomy remains underexplored. It was hypothesized that integrating simulation into standard tracheostomy training would improve caregiver confidence, performance, and readiness.

Methods: This prospective descriptive study used a pre-post design. Participants were caregivers of children (≤18 years) with new tracheostomies admitted to intensive care units at a tertiary pediatric hospital. All received standardized tracheostomy education, followed by two simulation sessions featuring four high-fidelity emergency scenarios: ventilator-related distress, tracheostomy obstruction, accidental decannulation, and hypoxia leading to cardiac arrest. Caregiver confidence was measured before and after training using a 10-item, 5-point Likert-scale survey. Response frequency changes were analyzed, and Likert items were scored (0–4) and summed to produce a composite confidence score (range 0–40). Demographics and qualitative feedback were collected. Tracheostomy-related ED visits and readmissions within 60 days were tracked.

Results: Twenty-one caregivers participated. Median total confidence scores increased from 34 (26–36) to 38 (36–40) out of 40 (p=0.0001). Significant gains were seen in preparedness to manage emergencies (28% to 72% strongly agree, p=0.003), performing CPR (24% to 78%, p=0.003), and recognizing respiratory distress (57% to 89%, p=0.02). Readiness for discharge rose (38% to 78%, p=0.002), and anxiety decreased (10% to 39% strongly disagree, p=0.03). Caregivers reported feeling more prepared and reassured. One tracheostomy-related ED visit occurred within 60 days.

Conclusions: High-fidelity simulation improved caregiver confidence, skills, and preparedness for tracheostomy emergencies. Practicing high-risk scenarios in a safe environment reinforced knowledge and boosted self-efficacy. Findings support simulation as a valuable addition to caregiver education, with potential to enhance safety and reduce emergency care use after discharge.