Practising evidence-based medicine: the design and implementation of a multidisciplinary team-driven extubation protocol

Background Evidence from recent literature shows that protocol-directed ext ubation is a useful approach to liberate patients from mechanical ventilati on (MV). However, research evidence does not necessarily provide guidance o n how to implement changes in individual intensive care units (ICUs). We co nducted the present study to determine whether such an evidence-based strat egy can be implemented safely and effectively using a multidisciplinary tea m (MDT) approach. Method We designed a MDT-driven extubation protocol. Multiple meetings were held to encourage constructive criticism of the design by attending physic ians, nurses and respiratory care practitioners (RCPs), in order to define a protocol that was evidence based and acceptable to all clinical staff inv olved in the process of extubation. It was subsequently implemented and eva luated in our medical/surgical ICU. Outcomes included response of the MDT t o the initiative, duration of MV and stay in the ICU, as well as reintubati on rate. Results The MDT responded favourably to the design and implementation of th is MDT-driven extubation protocol, because it provided greater autonomy to the staff. Outcomes reported in the literature and in the historical contro l group were compared with those in the protocol group, and indicated simil ar durations of MV and ICU stay, as well as reintubation rates. No adverse events were documented. Conclusion An MDT approach to protocol-directed extubation can be implement ed safely and effectively in a multidisciplinary ICU. Such an effort is vie wed favourably by the entire team and is useful in enhancing team building.