A A Chiang1, K C Lee, J C Lee, C H Wei. 1. Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China.
Abstract
OBJECTIVE: To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation. DESIGN: Prospective study over a 9-month period. SETTING: Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center. PATIENTS: 831 consecutive mechanically ventilated patients. INTERVENTIONS: CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients. MEASUREMENTS AND RESULTS: With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p = 0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively; p < 0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively; p = 0.92). CONCLUSIONS: The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
OBJECTIVE: To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation. DESIGN: Prospective study over a 9-month period. SETTING: Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center. PATIENTS: 831 consecutive mechanically ventilated patients. INTERVENTIONS: CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients. MEASUREMENTS AND RESULTS: With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p = 0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively; p < 0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively; p = 0.92). CONCLUSIONS: The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
Authors: Hari Krishnan Kanthimathinathan; Andrew Durward; Andrew Nyman; Ian A Murdoch; Shane M Tibby Journal: Intensive Care Med Date: 2015-05-19 Impact factor: 17.440
Authors: Philip Moons; Kristine Sels; Wilfried De Becker; Sabina De Geest; Patrick Ferdinande Journal: Intensive Care Med Date: 2004-03-25 Impact factor: 17.440
Authors: Farhad N Kapadia; Pandurang C Tekawade; Shruti S Nath; Sharad S Pachpute; Sanjay S Saverkar; Rupali A Bhise; Aarti C Chavan; Sholly J Varghese; Vidya U Kantak; Rohini V Kshirsagar; Vaishali A Neve; Samona O D'souza Journal: Indian J Crit Care Med Date: 2014-05