A Quality Improvement Initiative Improving Daily Extubation Rates in the ICU
CCCF ePoster library. Tsiaousidis Campbell V. Nov 9, 2018; 233374
Mrs. Vagia Tsiaousidis Campbell
Mrs. Vagia Tsiaousidis Campbell
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Abstract
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Introduction:



Mechanical ventilation (MV), a life sustaining treatment, is associated with complications leading to worsened patient outcomes. [1-6] Unnecessary risks associated with prolonged MV can be mitigated by reducing the duration of MV. [7-8] The aim of this study was to increase the daily E-R in patients who meet criteria, by 20% over a 10 month period in the ICU at Mount Sinai Hospital, Toronto, Canada.



Methods:



Using quality improvement methodology, key drivers were identified which enable extubation. A solution based process map generated change initiatives which were rolled out over a 13-week time series study; they included: Readiness Assessment Checklist, Earlier Assessment, Registered Respiratory Therapists (RRT) - Physician Extubation Huddle, and Medical Directive for RRT to Extubate.



Results:



The primary outcome of a 20% improvement in E-R was not achieved, yet a 13% increase was noted (Table1). Change idea compliance was very good for patient readiness and assessment; however inconsistent for the initiatives targeting medical orders. The Medical Directive initiative was not yet rolled out at the time of print. There was no change in Re-Intubation rates.














































Outcome Measures Extubation Rate 13% improvement
  Mechanical Ventilation Days Increasing trend, unstable baseline
Process Measures Readiness Assessment Checklist 100% compliance
  Earlier Assessment 94% compliance
  RRT - Physician Extubation Huddle 58.3% compliance
  Medical Directive for RRT to Extubate Not rolled out
Balancing Measures Re-Intubation Rates No special cause variation
  Self-Extubation Rate No special cause variation


 Table 1: Family of Measures



Conclusion:



The change ideas hypothesized to have the greatest impact on E-R were not successfully rolled out. A better understanding of the distribution of the root cause to extubation delay may have resulted in more focused interventions. Additionally, the use of Spontaneous Breathing Trials as readiness to extubate criteria may not be appropriate for all subset of patients. Future work should center on standardization of extubation criteria.


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