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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.
Insights
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.
Introduction:
Children who require an endotracheal (ET) tube for care during critical illness are at risk of unplanned extubations (UE), or the unintended dislodgement or removal of an ET tube that can lead to significant patient harm. A proposed national benchmark is 1 UE per 100 ventilator days. We aimed to reduce the rate of UEs in our intensive care units (ICUs) from 1.20 per 100 ventilator days to below the national benchmark within 2 years.
Methods:
We identified several key drivers including ET securement standardization, safety culture, and strategies for high-risk situations. We employed quality improvement methodologies including apparent cause analysis and plan-do-study-act cycles to improve our processes and outcomes.
Results:
Over 2 years, we reduced the rate of UEs hospital-wide by 75% from 1.2 to 0.3 per 100 ventilator days. We eliminated UEs in the pediatric ICU during the study period, while the UE rate in the neonatal ICU also decreased from 1.2 to 0.3 per 100 ventilator days.
Conclusion:
We demonstrated that by using quality improvement methodology, we successfully reduced our rate of UE by 75% to a level well below the proposed national benchmark.