Clinical quality improvement: eliminating unplanned extubation in the CCU

Abstract

Purpose

This article aims to explore coronary care unit (CCU) extubation structures, processes and outcomes. There were 13 unplanned-extubation cases (UE) among 251 intubated patients (5.2 per cent) in a cardiologist-led CCU in 2008. Seven did not require re-intubation, implying possible earlier extubation. A quality improvement project was undertaken with a goal to eliminate CCU UE within 12 months.

Design/methodology/approach

Using the clinical practice improvement (CPI) method, the most significant root causes were missing sedation/analgesia protocol, no ventilator weaning protocol and absent respiratory therapist during the CCU morning rounds. Non-physician directed sedation/analgesia and ventilation weaning protocols were created and put on trial in Plan-Do-Study-Act cycles before formal implementation. Arrangements were made to allocate a respiratory therapist to the CCU daily for morning rounds.

Findings

For 12 months after fully implementing the interventions, UE incidence dropped from 5.2 per cent to 0.9 per cent (p=0.006). There were no adverse outcomes, re-intubation and/or readmission to CCU within 48 hours.

Practical implications

Through a multi-disciplinary CPI approach, adopting non-physician directed protocols has successfully streamlined and improved airway management in mechanically ventilated patients in a cardiologist-led CCU.

Originality/value

There is little published data on improving intubated patient care in cardiologist-led CCUs. Previous studies centered on intensive care units managed by critical care specialists.

Citation

Chia, P.-L., Rapi Santos, D., Chai Tan, T., Leong, C. and Foo, D. (2013), "Clinical quality improvement: eliminating unplanned extubation in the CCU", International Journal of Health Care Quality Assurance, Vol. 26 No. 7, pp. 642-652. https://doi.org/10.1108/IJHCQA-12-2011-0079