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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review
Krista Wollny1,2,3,4, Sara Cui5, Deborah McNeil5,6
1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, PF 3239, Calgary, AB, T2N 1N4, Canada. krista.wollny@ucalgary.ca.
Insights
Quality improvement initiatives significantly reduced unplanned extubations in pediatric critical care. Most studies focused on guidelines, education, and communication, with seven showing statistically significant decreases in extubation rates.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Science
- Patient Safety Research
Background:
- Unplanned extubation is a critical quality indicator in pediatric intensive care units.
- This review synthesizes quality improvement (QI) practices aimed at reducing unplanned extubation rates in critically ill children.
Approach:
- Systematic review of primary research on QI interventions for unplanned extubations in pediatric critical care.
- Searched MEDLINE, Embase, and CINAHL databases.
- Categorized interventions using the Behavior Change Wheel and assessed study quality using QI-MQCS.
Key Points:
- Thirteen studies were included, with most describing primary QI projects.
- Common interventions included guidelines, environmental restructuring, education, training, and communication.
- Ten studies reported reduced unplanned extubation rates, seven with statistical significance.
Conclusions:
- QI interventions show promise in reducing unplanned extubations in pediatric critical care.
- There is a need for improved quality in the conduct and reporting of research in this area.
- Findings can inform clinical recommendations and enhance patient safety.
Background:
An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children.
Methods:
We included original, primary research on quality improvement interventions to reduce the rate of unplanned extubations in pediatric critical care. A search was conducted in MEDLINE (Ovid), Embase, and CINAHL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Vote counting based on the direct of effect was used to describe the effectiveness of quality improvement interventions. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive statistics and narrative syntheses.
Results:
Thirteen studies were included in the final review. Eleven described primary QI projects; two were sustainability studies that followed up on previously described QI interventions. Under half of the included studies were rated as high-quality. The median number of QI interventions described by each study was 5 [IQR 4-5], with a focus on guidelines, environmental restructuring, education, training, and communication. Ten studies reported decreased unplanned extubation rates after the QI intervention; of these, seven had statistically significant reductions. Both sustainability studies observed increased rates that were not statistically significant.
Conclusions:
This review provides a comprehensive synthesis of QI interventions to reduce unplanned extubation. With only half the studies achieving a high-quality rating, there is room for improvement when conducting and reporting research in this area. Findings from this review can be used to support clinical recommendations to prevent unplanned extubations, and support patient safety in pediatric critical care.
Systematic Review Registration:
This review was registered on PROSPERO (CRD42021252233) prior to data extraction.
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