Improving Unplanned Extubation Rates in a Single Pediatric Intensive Care Unit Led by a Respiratory Therapist.

Area of Science:

• Pediatric Critical Care Medicine
• Quality Improvement Science
• Patient Safety

Background:

• Unplanned extubations (UE) in critically-ill children lead to significant morbidity, mortality, and increased healthcare costs.
• Despite successful multi-center implementation of prevention bundles, UE rates persist as a common source of preventable harm.
• Existing prevention strategies require further enhancement for sustainable reduction.

Purpose of the Study:

• To achieve a 50% sustainable decrease in UE per 100 invasive ventilation days within a pediatric intensive care unit (PICU).
• To implement and evaluate multiple quality improvement interventions over a five-year period (2020-2025).
• To assess the impact of interventions on patient outcomes and balancing measures.

Main Methods:

• A longitudinal, multi-intervention quality improvement project in a single quaternary care PICU.
• Utilized Plan-Study-Do-Act (PDSA) cycles to drive iterative improvements.
• Built upon the initial implementation of the Solutions for Patient Safety Network UE prevention bundle, with a dedicated QI respiratory therapist.

Main Results:

• Achieved a 72.5% decrease in UE/100 invasive ventilation days, meeting criteria for a center line shift from 0.58 to 0.16.
• Sustained the reduced UE rate from Q1 2023 through Q2 2025 without adverse impact on balancing measures like invasive ventilation duration.
• Observed a decrease in the percentage of PICU patients requiring invasive ventilation (42% to 33%).

Conclusions:

• Multiple interventions, driven by a dedicated champion, significantly reduced and sustained UE rates in the PICU.
• The study validates the importance of building upon established prevention bundles for pediatric patient safety.
• Quality improvement initiatives can effectively decrease preventable harm without negatively affecting other critical care metrics.