EFFECTIVENESS OF A CONTINUOUS QUALITY IMPROVEMENT PROGRAM AIMING TO REDUCE UNPLANNED EXTUBATION - A PROSPECTIVE-STUDY

Objective: To evaluate the effectiveness of a continuous quality impro vement (CQI) program in reducing the incidence of unplanned endotrache al extubation. Design: Prospective study over a 9-month period. Settin g: Adult intensive care units (ICUs including coronary care unit, medi cal ICU, surgical ICU, and cardiovascular surgical ICU) in a universit y-affiliated medical center. Patients: 831 consecutive mechanically ve ntilated patients. Interventions: CQI program focusing on standardizat ion of procedures, improvement of communication, and identification an d management of high-risk patients.Measurements and results: With the implementation of this CQI program, the overall incidence density of u nplanned extubation (defined as number of new unplanned extubations pe r 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 resul t 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 remain ed largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respec tively; p=0.92). Conclusions: The implementation of a concerted CQI pr ogram is effective in reducing the overall incidence of unplanned endo tracheal extubation.