Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation : a prospective study.
To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation.
Prospective study over a 9-month period.
Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center.
831 consecutive mechanically ventilated patients.
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).
The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
Mots-clés Pascal : Ventilation mécanique, Intubation, Extubation, Complication, Evaluation, Qualité, Programme sanitaire, Homme, Organisation santé, Ventilation artificielle, Réanimation respiratoire, Soin intensif
Mots-clés Pascal anglais : Mechanical ventilation, Intubation, Extubation, Complication, Evaluation, Quality, Sanitary program, Human, Public health organization, Artificial ventilation, Respiratory intensive care, Intensive care
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0043907
Code Inist : 002B27B02. Création : 21/05/1997.