Improvement in Successful Extubation in Newborns After a Protocol-driven Approach: A Quality Improvement Initiative
To reduce extubation failure rate by implementing protocol-driven ventilation and extubation strategies.
Quality improvement project in a level II neonatal care unit from April 2017 to January 2018. Ventilation and extubation protocols implemented from 1 August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act (PDCA) cycle I and 17 in PDCA cycle II. Primary outcome was extubation failure within the first 72 h of extubation.
Extubation failure rate reduced from 41.7% (pre-protocol period) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to first extubation attempt significantly decreased (71.5 h to 38 h, P = 0.046).
A protocolized approach through quality improvement initiative demonstrated a sustained improvement in successful extubation with a significant reduction in the median time to first extubation attempt in ventilated newborns.
KeywordsExtubation failure Neonate Quality improvement Ventilation
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Acknowledgements Dr Sudhir Mishra, Head, Department of Pediatrics, Tata Main Hospital for his valuable inputs in revising the manuscript. Air Marshal (Dr) Rajan Chaudhry, AVSM, VSM (Retd.), GM (Medical Services), Tata Main Hospital, for providing permission to submit the manuscript for publication.