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Continuous quality improvement: reducing unplanned extubations in a pediatric intensive care unit
Roxanne Sadowski1, Ronald E Dechert, Kenneth P Bandy
1Department of Critical Care Support Services, University of Michigan Health System, 200 East Hospital Dr, F5815 Box 0208, Ann Arbor, MI 48109, USA. rsadowsk@umich.edu
Pediatrics
|September 3, 2004
Summary
Unplanned extubation (UEX) in pediatric intensive care units is linked to longer ventilation and hospital stays. Targeted interventions and monitoring programs helped reduce UEX rates in children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Patient Safety
Background:
- Unplanned extubation (UEX) is a significant complication in pediatric intensive care units (PICUs), often leading to increased morbidity.
- Limited data exists on factors contributing to UEX and reintubation in pediatric populations.
- Assessing UEX incidence and associated patient conditions is crucial for improving care.
Purpose of the Study:
- To determine the incidence of UEX in a PICU over a 5-year period.
- To identify patient characteristics and conditions associated with UEX.
- To evaluate the impact of targeted interventions on UEX rates.
Main Methods:
- Prospective data collection on all patients requiring artificial airways in the PICU over 5 years.
- Detailed information gathered for patients experiencing UEX, including demographic and clinical data.
- Implementation and iterative modification of educational sessions and care management protocols based on monitoring findings.
Main Results:
- A total of 164 UEXs occurred in 141 of 2192 patients (6%), with an overall rate of 1.2 UEXs per 100 airway days (AWD).
- The UEX rate decreased from 1.5 to 0.8 per 100 AWD over the study period.
- Younger children (<5 years) had higher UEX rates; UEX patients experienced longer mechanical ventilation (6 vs. 3 days) and PICU stays (8 vs. 4 days).
- Forty-six percent of UEXs occurred during weaning, with 22% requiring reintubation.
Conclusions:
- UEX in pediatric patients is associated with prolonged mechanical ventilation and PICU length of stay.
- A continuous quality improvement program, including monitoring and education, effectively reduced UEX rates.
- Identifying high-risk (younger children) and low-risk (weaning patients for reintubation) populations informed targeted interventions.