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Reducing Unplanned Extubations Across a Children's Hospital Using Quality Improvement Methods.

Sarah B Kandil1, Beth L Emerson1, Michael Hooper1

  • 1Department of Pediatrics, Yale School of Medicine, New Haven, Conn.

Pediatric Quality & Safety
|July 24, 2019
PubMed
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Unplanned extubations (UEs) in critically ill children were reduced by 75% using quality improvement methods. This success brought the rate of UEs below the national benchmark, enhancing patient safety in intensive care units.

Area of Science:

  • Pediatric Critical Care Medicine
  • Quality Improvement Science
  • Patient Safety

Background:

  • Children in intensive care units (ICUs) are at risk of unplanned extubations (UEs), which can cause harm.
  • A national benchmark for UEs is 1 per 100 ventilator days.
  • The study's baseline UE rate was 1.20 per 100 ventilator days.

Purpose of the Study:

  • To reduce the rate of unplanned extubations (UEs) in pediatric and neonatal intensive care units.
  • To achieve a UE rate below the proposed national benchmark within two years.

Main Methods:

  • Implementation of standardized endotracheal (ET) tube securement.
  • Fostering a safety culture within ICUs.
  • Development of strategies for managing high-risk situations.

Related Experiment Videos

  • Utilizing quality improvement methodologies like apparent cause analysis and plan-do-study-act cycles.

    • Main Results:

    • Achieved a 75% reduction in hospital-wide UEs over two years.
    • Reduced the UE rate from 1.2 to 0.3 per 100 ventilator days.
    • Eliminated UEs in the pediatric ICU and significantly decreased them in the neonatal ICU.

    Conclusions:

    • Quality improvement methodology is effective in reducing unplanned extubations.
    • The study successfully lowered UE rates significantly below the national benchmark.
    • These interventions enhanced patient safety for critically ill children requiring mechanical ventilation.