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Advancing extubation time for cardiac surgery patients using lean work design.

Jacob T Gutsche1, Lee Erickson2, Kamrouz Ghadimi1

  • 1Department of Anesthesiology and Critical Care.

Journal of Cardiothoracic and Vascular Anesthesia
|September 30, 2014
PubMed
Summary

Redesigning care processes with Lean principles significantly increased early extubation rates in cardiac surgery patients. This led to a dramatic rise in patients extubated within six hours, improving patient outcomes.

Keywords:
aortic valve replacementcoronary artery bypass graftcritical careearly extubationextubationlean designmitral valve replacementquality improvement

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Area of Science:

  • Cardiac Surgery
  • Intensive Care Medicine
  • Process Improvement

Background:

  • Early extubation in cardiac surgery reduces intubation and hospital stay.
  • Limited research exists on studying and redesigning care processes to boost early extubation rates.

Purpose of the Study:

  • To enhance early extubation rates by redesigning patient care processes.
  • Utilized Lean principles to identify and eliminate barriers to early extubation.
  • Implemented guideline management to facilitate early extubation.

Main Methods:

  • Retrospective data analysis in a 16-bed academic community hospital ICU.
  • Analyzed care processes for 404 cardiac surgery patients (CABG, AVR, MVR/repair) using Lean methodologies.
  • Identified root causes of delays including hypothermia, prolonged weaning, hypertension management, and equipment delays.

Main Results:

  • Early extubation rates increased from 27% to 50% post-intervention (p=0.0001).
  • Median intubation length decreased from 9.7 to 6.1 hours (p=0.0019).
  • Age, renal failure, and gender were also predictors of early extubation.

Conclusions:

  • A coordinated and integrated care paradigm significantly improved the likelihood of early extubation.
  • Lean methodology effectively addressed barriers to early extubation in cardiac surgery patients.
  • The redesigned care processes demonstrated a substantial positive impact on patient recovery.