Wide Variation in Unplanned Extubation Rates Related to Differences in Operational Definitions

Area of Science:

• Neonatal intensive care
• Patient safety metrics
• Quality improvement

Background:

• Unplanned extubation (UE) is a critical patient safety metric.
• Existing definitions of UE are inconsistently interpreted, leading to varied rates.
• Accurate measurement of UE is essential for quality improvement.

Purpose of the Study:

• To evaluate the impact of different operational definitions on unplanned extubation (UE) rates.
• To determine how varying UE definitions affect the sensitivity of this patient safety metric.
• To inform standardized definitions for accurate UE rate calculation.

Main Methods:

• Analysis of quality improvement data from a neonatal intensive care unit (NICU).
• Classification of unplanned extubations (UEs) as 'dislodged' or 'removed' endotracheal tubes (ETTs).
• Descriptive statistics used to compare UE rates across different definitions.

Main Results:

• 241 UEs documented over 33 months; 70% involved dislodged ETTs, 30% removed by staff.
• Only 9% of dislodged ETTs were fully externalized; 77% were in the esophagus.
• Using a narrow definition (self-extubation, reintubation, within NICU) excluded 83% of UEs.

Conclusions:

• Most UEs in NICU settings involve staff actions or partial ETT dislodgement.
• Excluding staff-removed ETTs significantly underestimates UE rates and associated risks.
• An inclusive, patient-centric definition and standardized classification are crucial for benchmarking and targeted interventions.