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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
Summary
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.
- 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.