Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement...

Area of Science:

• Pediatric Surgery
• Quality Improvement Science
• Neonatal Intensive Care

Background:

• Unplanned intubation post-pediatric surgery increases mortality.
• The Neonatal Intensive Care Unit (NICU) was identified as a high-outlier area for these events.
• A quality improvement project was initiated to address this critical issue.

Purpose of the Study:

• To reduce postoperative unplanned intubation events by 25% within one year.
• To implement targeted interventions in the NICU setting.
• To improve patient safety and outcomes following pediatric surgery.

Main Methods:

• A multidisciplinary team developed interventions based on case reviews.
• Implemented an extubation readiness checklist and a non-opioid pain management guideline.
• Utilized statistical process control methods for prospective tracking and evaluation.

Main Results:

• Achieved a 76% reduction in unplanned intubations in the NICU (0.07 vs 0.27 events/patient).
• Significant decrease in postoperative opioid use, with increased acetaminophen administration.
• No significant difference in pneumonia rates or hospital length of stay.
• A significant decline in 30-day mortality rate for NICU patients (0.7% vs 6.5%).

Conclusions:

• Quality improvement efforts focusing on opioid stewardship and extubation readiness effectively reduced unplanned intubations in NICU patients.
• The interventions led to improved patient safety and reduced mortality.
• This study highlights the success of targeted quality improvement in pediatric surgical care.