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.
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Mailing address: Maria Parham Hospital, 1801 Ruin Creek Rd, Suite 002, Henderson, NC 27536, USA FAX: +1(919) 431-2088
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Chiang, A.A., Lee, K.C., Lee, J.C. et al. Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: A prospective study. Intensive Care Med 22, 1269–1271 (1996). https://doi.org/10.1007/BF01709348
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DOI: https://doi.org/10.1007/BF01709348