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I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program
Michael R Cassidy1, Pamela Rosenkranz, Karen McCabe
1Department of Surgery, Boston University Medical Center, Boston, Massachusetts.
JAMA Surgery
|June 7, 2013
Summary
Postoperative pulmonary complications, including pneumonia and unplanned intubation, were significantly reduced by implementing the I COUGH program. This multidisciplinary approach enhances patient education and early mobilization, improving surgical outcomes.
Area of Science:
- Medical Research
- Surgical Care
- Pulmonary Medicine
Background:
- Postoperative pulmonary complications pose significant risks to surgical patients.
- Validated strategies are crucial for mitigating these adverse events.
- The I COUGH program was developed to address this need.
Purpose of the Study:
- To design and implement the I COUGH program.
- To evaluate the efficacy of I COUGH in reducing postoperative pulmonary complications.
Main Methods:
- A before-after trial was conducted at an urban academic safety-net hospital.
- The study included general and vascular surgery patients over a 1-year period before and after I COUGH implementation.
- I COUGH is a multidisciplinary program focusing on incentive spirometry, coughing, oral care, education, early mobilization, and head-of-bed elevation.
Main Results:
- The incidence of postoperative pneumonia decreased from 2.6% to 1.6%.
- The incidence of unplanned intubations decreased from 2.0% to 1.2%.
- Risk-adjusted outcomes for both pneumonia and intubation showed significant improvement post-implementation.
Conclusions:
- The I COUGH program effectively reduces the incidence of postoperative pneumonia and unplanned intubation.
- Standardized postoperative care emphasizing education and mobilization improves patient outcomes.
- I COUGH offers a valuable strategy for enhancing surgical pulmonary care.
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