Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery.

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Healthcare Management

Background:

• The incidence of prolonged mechanical ventilation (>24 hours) post-coronary artery bypass graft (CABG) surgery was notably high (26.9%) at the study institution in 2010.
• This rate significantly exceeded the national average for similar hospitals (10.9%).

Purpose of the Study:

• To implement lean management principles to decrease the occurrence of prolonged mechanical ventilation in CABG patients.
• To evaluate the long-term sustainability of these reductions.

Main Methods:

• A multidisciplinary task force identified key areas for improvement.
• Interventions included a standardized extubation protocol, enhanced communication tools (dry erase boards), and optimized electronic health record order sets.
• Outcomes were compared pre- and post-intervention.

Main Results:

• Significant reductions were observed in median mechanical ventilation hours (11.4 to 6.9 hours) and the rate of prolonged ventilation (29.4% to 8.6%).
• The rate of reintubation did not significantly increase.
• The reduction in prolonged ventilation was sustained for four years post-intervention.

Conclusions:

• Lean management interventions, supported by a multidisciplinary team and ongoing staff education, effectively reduced prolonged mechanical ventilation after CABG surgery.
• The implemented strategies proved sustainable over a four-year period.