Reducing Pediatric Unplanned Extubation: A National Quality Improvement Collaborative.

Area of Science:

• Pediatric Patient Safety
• Quality Improvement Science
• Healthcare Management

Background:

• Unplanned extubation (UE) poses significant harm to pediatric patients.
• A validated UE reduction bundle was previously developed by the Solutions for Patient Safety collaborative.
• The need to spread this effective intervention across numerous children's hospitals was identified.

Purpose of the Study:

• To disseminate the UE reduction bundle to a wide network of children's hospitals.
• To utilize workgroups as a primary mechanism for facilitating bundle implementation and spread.
• To achieve a sustained reduction in unplanned extubation rates nationally.

Main Methods:

• Eighty-three pediatric hospitals implemented the UE bundle across intensive care units.
• Hospitals utilized structured workgroups for barrier identification, problem-solving, and resource sharing.
• Data on UE rates and bundle reliability were collected and submitted to the collaborative.

Main Results:

• The overall network UE rate decreased by 19.9% (from 0.662 to 0.53 per 100 ventilator days).
• 74% of participating hospitals achieved significant UE rate reductions or improved bundle reliability.
• Workgroups successfully identified and addressed implementation and auditing barriers, with most hospitals maintaining improvements.

Conclusions:

• Workgroups are an effective strategy for spreading quality improvement interventions in large healthcare collaboratives.
• Peer-to-peer learning and resource sharing within workgroups facilitated sustained improvements in patient safety.
• Children's hospitals can effectively reduce unplanned extubations through structured, collaborative quality improvement efforts.