Since the simulation program at Children's Hospital Colorado (CHCO) was established in 2013, our team has been working with CHCO's Breathing Institute to improve discharge education for families of children dependent on a tracheostomy or ventilator. Because many of these families return to states in which there is limited home care assistance available, effective education prior to discharge is critical.

CHCO's Simulation Lab and Breathing Institute teams have made great strides in improving family care and preparing caregivers for their child's home care. Striving to simulate each patient's home environment in order to best acclimate patient families to vital patient care, we use high-fidelity manikins to educate families on clinical and functional interventions.

Initially, this simulation was achieved through the use of an adolescent-sized, high-fidelity manikin with a tracheostomy. We quickly discovered, however, that this particular manikin did not fit the fidelity needs of families who had infants.

Through inquiries with various vendors and conversations with other children's hospital simulation program teams, we discovered that a factory-made infant-sized manikin with a working tracheostomy did not exist. Some simulation programs were using a workaround — hiding a tube-like piece of equipment under the neck skin of an infant manikin that allowed caregivers to practice removing and inserting the trach tube, give rescue breaths and mimic CPR.

However, this method did not show the desired, life-like effects of any of the airway interventions the families would attempt. In other words, when they administered air through the tracheostomy, it did not show the chest rising in response.

Our program team believes life-like response is crucial to providing the best learning experience for patient families. Thanks to a generous donation, we were able to purchase an infant-sized high-fidelity manikin and create our own clinically functional and life-like tracheostomy.

How did we do it?

First, we examined the manikin's internal airway structure and practiced with spare parts identical to those inside of the manikin before they moved forward with their "surgical procedure." We then used surgical instruments, spare airway parts and specialty adhesive to build a trached airway.

After the modified airway was thoroughly tested for strength and functionality, we inserted it into the manikin and began the slow reconstructive efforts to make the opening appear realistic. Once completed, a tracheostomy tube could be easily inserted, removed and ventilated with a mechanical ventilator or air delivery device.

This new manikin showed realistic chest rise and response, and mouth or nose ventilation also became possible if the tracheostomy tube had to be removed and the stoma covered with a finger.

Outcomes of the discharge education and simulation training have been encouraging.

Since 2013, the length of stay for CHCO's vent care families has decreased approximately 42 percent, and feedback from patient families who participate in the simulation program has been overwhelmingly positive. Other outcome measures, including readmission rates, are currently being evaluated.