Counting unplanned extubations: marked variation among neonatologists

Area of Science:

• Neonatal Medicine
• Clinical Practice Improvement
• Patient Safety

Background:

• Unplanned extubations (UEs) are a significant concern in neonatal intensive care.
• Consistent tracking and reporting of UEs are crucial for quality improvement initiatives.

Purpose of the Study:

• To evaluate the uniformity of UE detection and counting practices among neonatologists.
• To identify factors contributing to UEs and variations in their classification.

Main Methods:

• Anonymous web-based survey administered to neonatology attending and fellow members.
• Survey included questions on UE tracking practices and case scenarios for classification.

Main Results:

• 61% of 509 respondents track UE rates, with 53% reporting 1-3 UEs per 100 ventilator days.
• Patient-related endotracheal tube (ETT) dislodgement and ETT holding system failure were top perceived causes.
• Significant variation (19-62%) in counting UEs occurred when staff removed the ETT, even by attending physicians.

Conclusions:

• Wide variation exists in neonatologists' methods for detecting and counting UEs, hindering inter-institutional comparisons.
• Standardized definitions and classifications are proposed to enable benchmarking and drive collaborative efforts to reduce UEs in neonates.