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A prospective observational quality improvement study of the sustained effects of a program to reduce unplanned
Bonnie R Rachman1, Richard B Mink
1Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, CA 90509, USA. brachman@labiomed.org
Insights
A quality improvement program successfully maintained a low rate of unplanned extubation in a pediatric intensive care unit (PICU) for nine years. This demonstrates the long-term effectiveness of sustained quality initiatives in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Science
- Patient Safety
Background:
- Unplanned extubation in critically ill children leads to significant morbidity and mortality.
- Routine endotracheal intubation necessitates strategies to prevent adverse events.
- Minimizing unplanned extubations is crucial for improving patient outcomes in pediatric intensive care.
Purpose of the Study:
- To prospectively evaluate the sustained effectiveness of a quality improvement program implemented nine years prior.
- To determine if the program continued to maintain a low rate of unplanned extubation in a pediatric intensive care unit (PICU).
Main Methods:
- Prospective, observational study design.
- Data collected from a 10-bed urban, county, teaching hospital's PICU.
- Included all intubated pediatric patients over a one-year period (February 2009-2010).
Main Results:
- The unplanned extubation rate decreased from 6.4 to 1.0 per 100 ventilated days after program implementation in 2000.
- Nine years later, the rate remained low at 1.5 per 100 ventilated days, showing sustained success (P > 0.05).
- No significant differences were observed in patient demographics or intubation characteristics.
Conclusions:
- The quality improvement program has been successful in sustaining reduced rates of unplanned extubation over nine years.
- Periodic reevaluation of quality improvement initiatives is essential to ensure ongoing effectiveness.
- This initiative highlights the importance of long-term commitment to quality in pediatric critical care.
Background:
The use of endotracheal intubation is routine in the care of critically ill children. Unplanned extubation exposes the patient to morbidity and mortality over and above that associated with the patient's underlying disease. All unplanned extubations are unacceptable because of their potential for causing unnecessary harm to the patient.
Objective:
To prospectively determine whether a quality improvement program adopted 9 years ago has continued to be successful in maintaining a low rate of unplanned extubation in our pediatric intensive care unit (PICU).
Design:
Prospective, observational study.
Setting:
10-bed PICU in an urban, county, teaching hospital.
Patients:
All intubated pediatric patients in the PICU from February 15, 2009 to February 14, 2010.
Intervention:
None.
Measurements And Results:
Prior to the implementation of the program in 2000, our PICU had an unplanned extubation rate of 6.4 unplanned extubations per 100 ventilated days. After implementation of the quality improvement program, the rate of unplanned extubation decreased to 1.0 unplanned extubation per 100 ventilated days. In this study, we reevaluated the unplanned extubation rate 9 years after the implementation of the quality improvement program. We found that the rate had remained unchanged (P > 0.05): 1.5 unplanned extubations per 100 ventilated days as compared to 1.0 unplanned extubation per 100 ventilated days. There were no significant differences (P > 0.05) in age, weight, endotracheal tube size, duration of intubation or rate of unplanned extubation.
Limitations:
In this study, no randomization took place, in which one group was not subject to the quality improvement program. We did not account for potential changes in severity of illness or staffing issues.
Conclusions:
In the 9 years since implementation, our program has remained successful in decreasing unplanned extubations. It is important to periodically reevaluate quality improvement programs to determine whether they have continued to achieve their intended goals. The initiative is reported here using the Standards for Quality Improvement Reporting Excellence (SQUIRE).
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...