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Resident-Championed Quality Improvement Provides Value: Confronting Prolonged Mechanical Ventilation
Adil J Malek1, Claire L Isbell1, Mary M Mrdutt1
1Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas.
The Journal of Surgical Research
|July 20, 2020
Summary
Resident-led quality improvement initiatives identified that preoperative patient factors significantly increase the risk of prolonged mechanical ventilation (PMV). This highlights the need for early identification and optimization of high-risk surgical patients to improve outcomes.
Area of Science:
- Medical Education
- Surgical Quality Improvement
- Patient Safety
Background:
- The Quality In-Training Initiative (QITI) offers hands-on quality improvement education for surgical residents.
- The institution's prolonged mechanical ventilation (PMV) rates were in the bottom quartile per the National Surgical Quality Improvement Program (NSQIP).
Purpose of the Study:
- To determine perioperative contributors to PMV using a resident-led quality improvement project.
- To investigate the role of preoperative patient factors in PMV.
Main Methods:
- A retrospective case-control study compared preoperative NSQIP risk calculator profiles of PMV patients to matched controls.
- Ventilator time, 30-day outcomes, and all-cause mortality were assessed via chart review.
Main Results:
- PMV patients had significantly higher NSQIP predicted risk percentages for complications, length of stay, and death (P < 0.05).
- The PMV group experienced worse 30-day outcomes, including sepsis, pneumonia, reoperation, mortality, and longer hospital stays (P < 0.05).
Conclusions:
- Resident-led QITI projects effectively enhance education and identify areas for care improvement.
- Preoperative patient factors significantly contribute to PMV at this institution.
- Future efforts will focus on the preoperative identification and optimization of high-risk patients.
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