Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: a prospective study.

Abstract

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. 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.