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Description
QUALITY
Background: The pediatric critical care unit in a large medical center benchmarks a variety of quality metrics to ensure we are providing our patients with the best care. At the end of 2023, the unit rate of 0.58 was higher than the national benchmark rate of 0.33 for unplanned extubation (UE). Additionally, the unit was lower for failed extubation rate than the national benchmark which led to questioning if the unit was too conservative with when patients are deemed ready to extubate.
Objectives: The primary goal is to lower the rate of UE while maintaining a failed extubation rate lower than the national benchmark. The secondary goal is to reduce the time between extubation readiness testing (ERT) or a spontaneous breathing trial (SBT) and extubation.
Methods: A quality improvement (QI) team was created and tasked with an urgent timeline to reduce UE. The team implemented a peri-extubation checklist and has completed three PDSA cycles in the first 6 months of the project. Data collection began in April and will complete in August 2024.
Results: The 2024 UE rate through June decreased 87% when compared to the 2023 rate through June. With the average UE costing $101,0001, this is a reduction in costs of $707,000 through Q2 2024. The baseline time elapsed between an ERT/SBT and extubation was a median of 11.5 hours during Q4 2023. Utilization of the checklist decreased that time to a median of 6 hours and 34 minutes. This is a statistically significant reduction with p < 0.01. The year-to-date failed extubation rate was 2.79% as of June 2024. This is largely unchanged from 2023. Staff feedback was also generally positive.
Conclusion & Implications: Short-term QI projects such as checklist development can encourage multidisciplinary engagement and reduce the frequency of unplanned events.
1Solutions for Patient Safety (2017). SPS Value Calculator. [Excel file]. Retrieved from www.solutionsforpatientsafety
Publication Date
9-27-2024
Keywords
Respiratory Care, Extubations, PICU, Pediatric Intensive Care
Disciplines
Pediatric Nursing
Recommended Citation
Huntington, Leslie; Jordan Ressman, Emily; and Yearego, Carmen, "Little Lungs, Big Care: Prevent Unplanned Extubation" (2024). 2024. 11.
https://scholarlycollection.childrens.com/nursing-anf2024/11
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
