Postoperative photography reduces incorrect wound breakdown diagnoses in tracheostomy

Purpose: This study was performed to investigate the effect of including immediate postoperative photographs of a tracheostomy site on diagnoses (correct and incorrect) of wound breakdown in a pediatric patient population. Materials and methods: Chart review was performed of all patients from 2017 to 2019 who underwent a tracheostomy. Within this time span, the practice of the hospital changed such that postoperative photography was taken of the tracheostomy site. There were no changes in in-service training protocols over this time. Wound breakdown diagnoses were examined prior to and after the intervention. Diagnoses were categorized by severity according to the National Pressure Ulcer Advisory Board. Diagnoses were then divided into correct or incorrect based on examination by physician teams at the time of the diagnosis. Results: Forty five patients underwent a tracheostomy during the study period. When comparing the two groups, there was a reduction in all wound breakdown diagnosis by 91 %, and those diagnoses which were entered into the chart after the photos were verified as correct. Conclusions: Without appropriate context as to the nature of tracheostomy wounds, many providers may incorrectly grade a healthy wound as wound degradation, which can affect care, reimbursement, and hospital ratings. We present our findings of placing an intraoperative wound photo in the patient's electronic medical record as a reference should wound concerns arise. We believe this is an easy action which can enhance patient care, decrease unnecessary work, and provide an accurate documentation of tracheostomy care pathways and results.