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Measuring Critical Care Unit Performance Using a Postoperative Mechanical Ventilation Quality Metric.
David K Werho1, Anna Fisk2, Justin Yeh3
1Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, UC San Diego, San Diego, California.
The Annals of Thoracic Surgery
|December 5, 2022
Summary
Cardiac intensive care unit (CICU) performance in mechanical ventilation duration after congenital heart surgery varies widely. Key organizational factors like staffing and occupancy influence ventilation times, offering targets for quality improvement.
Area of Science:
- Pediatric Cardiac Critical Care
- Quality Improvement Metrics
- Mechanical Ventilation Management
Background:
- Minimizing postoperative mechanical ventilation duration is a critical quality measure in cardiac intensive care units (CICUs) following congenital heart surgery.
- Assessing CICU performance requires standardized metrics that account for patient complexity and illness severity.
Purpose of the Study:
- To measure cardiac intensive care unit (CICU) performance using the duration of postoperative mechanical ventilation after congenital heart surgery.
- To identify organizational factors associated with variations in postoperative mechanical ventilation duration across different CICUs.
Main Methods:
- An observational analysis of 16,848 surgical hospitalizations across 26 Pediatric Cardiac Critical Care Consortium CICUs was conducted.
- A multivariable model predicted postoperative mechanical ventilation duration, adjusting for pre- and postoperative factors to assess CICU performance.
- Observed-to-expected (adjusted) ventilation duration ratios were calculated for each CICU, and organizational characteristics were explored for their association with adjusted ventilation duration.
Main Results:
- Significant variation in adjusted ventilation duration ratios was observed across CICUs, ranging from 0.7 to 1.7.
- Nine CICUs demonstrated statistically better-than-expected ventilation duration, while ten showed significantly worse performance.
- Shorter adjusted ventilation duration was associated with mixed attending staffing, lower attending-to-patient ratios, moderate CICU occupancy (80%-90%), and higher nurse staffing levels and experience.
Conclusions:
- Cardiac intensive care unit (CICU) performance in managing postoperative mechanical ventilation duration after congenital heart surgery exhibits substantial variability.
- Several potentially modifiable organizational factors, including staffing models, patient ratios, occupancy, and nurse experience, are linked to ventilation duration.
- These findings provide a basis for targeted quality improvement initiatives at underperforming CICUs to optimize mechanical ventilation management.
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