695

Abstract

Introduction: Prolonged mechanical ventilation after cardiac surgery is associated with prolonged length of stay and increased morbidity and mortality. Shorter postoperative ventilation times are accepted as a marker of quality. We implemented quality improvement efforts and methodology to reduce postoperative MV times for cardiac surgery patients in our cardiovascular intensive care unit. Methods: Baseline time-to-extubation data was obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). An institutional unit-based data collection form was instituted to allow real-time assessment of extubation times. To inform quality improvement efforts, data was collected on demographics, surgery type, medical history, and mechanical ventilation times on all critically ill adult postoperative cardiac surgery patients for 2.5 months. Individual patient-specific times to extubation were placed in run charts. Improvement actions implemented included informal education of members of the healthcare team about prolonged extubation times, renewed focus on non-physician driven extubation protocol for weaning mechanical ventilation, and implementation time-oriented goals for extubation. Extubation-time data was analyzed in run charts to determine whether system changes had produced a change in median mechanical ventilation times. Standard run chart rules were used to determine whether a statistically significant shift in median mechanical ventilation times had occurred. Results: Baseline unit STS ACSD median postoperative mechanical ventilation time from January 2013 through March 2013 was 9.48 hours. After initiation of quality improvement efforts, run charts demonstrated a shift in median ventilation time to 4.7 hours. Conclusions: Median postoperative mechanical ventilation times for cardiac surgery patients were reduced after quality improvement efforts which included real-time data collection, informal education about mechanical ventilation times, emphasis of a non-physician driven mechanical ventilation weaning protocol, and time-oriented goals for extubation. System changes produced median extubation times lower than the STS ACSD 2012 national median postoperative ventilation time of 6.8 hours. Run chart methodology proved useful in monitoring system change during quality improvement efforts in this cardiovascular intensive care unit.