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Updated: May 10, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Reducing Pediatric Unplanned Extubation: A National Quality Improvement Collaborative
Kristin Melton1, Anthony Lee2, Jason Macartney3
1Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Workgroups effectively spread a bundle to reduce unplanned extubations (UE) in children's hospitals. This initiative led to a 19.9% reduction in UE events, demonstrating improved patient safety through collaborative learning and resource sharing.
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.
Objective:
Unplanned extubation (UE) is a significant cause of harm for pediatric patients. Hospitals working with a quality improvement collaborative, Solutions for Patient Safety, tested and developed a UE bundle that demonstrated significant UE reduction after implementation. The objective of this study was to spread the UE bundle to a large number of children's hospitals using workgroups to facilitate bundle implementation for UE reduction.
Methods:
Pediatric hospitals implemented the UE bundle in their neonatal, pediatric, and cardiac intensive care units and submitted data on their UE rate (UE number per ventilator days) and reliability to the bundle. Participating hospitals were divided into smaller workgroups that were used to identify barriers to bundle implementation, measurement, and maintenance. Workgroups were used to facilitate peer-to-peer discussion and sharing of resources, tools, and ideas.
Results:
Eighty-three hospitals participated in workgroups between January 2020 and July 2023. During that time, the overall network rate of UE was reduced from 0.662 UE events per 100 ventilator days to 0.53 UE events per 100 ventilator days, representing a 19.9% reduction in UE events. After participating in workgroups, 53 hospitals (74%) experienced significant UE rate reductions or a significant increase in reliability to the bundle. Most hospitals maintained stable UE rates and reliability. Barriers to bundle implementation and auditing were identified and addressed in the workgroups.
Conclusions:
The use of workgroups was an effective method to facilitate bundle spread, support group learning, and provide resources to promote improvement efforts in a large improvement collaborative. Through structured improvement methods, children's hospitals have continued to decrease the rate of UE.
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