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Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study

Abstract

Purposes

To evaluate the incidence of unintended tube, line, and drain removals (UTRs) in our ICU, to identify system factors associated with UTRs, and to evaluate interventions designed to decrease UTR occurrence.

Methods

Interventional study in the 18-bed medical ICU of a French general university hospital. We prospectively determined the incidence and circumstances of UTRs in our ICU over a 2-year period. Demographic and clinical data were collected for consecutively admitted patients, and additional information was recorded about patients experiencing UTRs. Investigators analyzed UTR data twice a month to identify possible causes and developed interventions to decrease UTRs (mainly securing tubes and sedation protocol). Conditional logistic regression stratified on length of stay was used to identify risk factors for UTRs and segmented linear regression analysis to test the effects of interventions.

Results

Of 2,007 admitted patients (12,256 patient days), 193 (9.6%) experienced 270 UTRs (22/1,000 patient days). Clinical or therapeutic consequences occurred for 17% of UTRs. Three factors were independently associated with UTR; two were risk factors, namely, admission for coma [OR, 2.68; 95% CI (1.87; 3.84); P < 0.0001] and mechanical ventilation in over 65% of all ICU patients [OR = 1.65 (1.19; 2.29); P = 0.003], and one was protective, namely, mean SAPS II >45 in all ICU patients [OR, 0.54; 95% CI (0.39; 0.75); P = 0.0003]. Segmented regression analysis showed a 67.4% drop [95% CI (17.2%; 117.3%); P = 0.009] in the UTR rate after the first intervention was introduced. System factors played a major role in UTR occurrence.

Conclusion

UTRs are common. A continuous quality-improvement program can reduce UTR rates in the ICU.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Jean-François Timsit.

Additional information

The article was written on behalf of the FRATER study group. FRATER is the acronym for French Risk Assessment for TubE Removal, whose participants are listed in the appendix.

Electronic supplementary material

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Appendix

Appendix

Members of the FRATER study group

Scientific committee

Rebecca Hamidfar-Roy MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Patricia Peurois, Medical ICU, Michallon Teaching Hospital, Grenoble.

Alexis Tabah, Medical ICU, Michallon Teaching Hospital, Grenoble.

Alexandra Michel-Herzberg RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Laure Hammer MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Nadège Oudart RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Agnès Bonadona MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Maria Dacosta RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Biostatistical and informatics expertise

Adrien Francais M.Sc, Outcomerea, Inserm U823, Team Outcome of Cancer and Critical Illness, Grenoble, France.

Aurélien Vesin M.Sc, Outcomerea, Inserm U823, Team Outcome of Cancer and Critical Illness, Grenoble, France.

Timsit Jean-Francois, Outcomerea, Inserm U823; University Joseph Fourier (Grenoble 1); Grenoble, France.

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Calvino Günther, S., Schwebel, C., Vésin, A. et al. Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study. Intensive Care Med 35, 1772–1776 (2009). https://doi.org/10.1007/s00134-009-1555-8

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  • DOI: https://doi.org/10.1007/s00134-009-1555-8

Keywords

  • Tube removal
  • Intensive care
  • Intervention
  • Adverse event
  • Quality of care