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Abstract
For patients in the intensive care unit (ICU), prolonged mechanical ventilation is associated with poor outcomes. A quality improvement (QI) initiative with the aim of reducing median time on the ventilator for tracheostomy patients was undertaken at a tertiary care ICU in Toronto, Canada. A QI team was formed, and using QI methodology, a deep understanding of our local process was achieved. Based on this information and on the latest evidence on weaning, a standard tracheostomy weaning protocol was designed. The protocol was refined through three developmental and two testing plan–do–study–act cycles. This study was a prospective time series showing the effect of the implementation of our intervention on tracheotomy patients’ time on the ventilator. The baseline median number of days on the ventilator after tracheostomy insertion was 17. Within 12 months of the introduction of the intervention, a shift in the data showing a reduction in the median time on the ventilator to 10.6 days had developed. Length of stay in the ICU was reduced by 4.3 days. Adherence and compliance to the protocol also improved over time. A standard tracheostomy weaning protocol was successfully developed, tested and implemented in a tertiary care ICU. Using strategies such as frequent communication with key stakeholders and incorporating a tracheostomy weaning progress sheet to document and track tracheostomy patients and their outcomes, this QI intervention has become engrained in the local culture at our centre. This weaning protocol has successfully reduced the median time on the ventilator for tracheostomy patients by over 6 days.
- Critical care
- Evidence-based medicine
- Implementation science
- Patient-centred care
- Quality improvement
Data availability statement
Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials. Raw data from which these findings are derived are stored on a secure hard drive at St. Joseph’s Health Centre and available from the corresponding author (MM) on request.
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Data availability statement
Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials. Raw data from which these findings are derived are stored on a secure hard drive at St. Joseph’s Health Centre and available from the corresponding author (MM) on request.
Footnotes
Contributors MM, MB, JC, CB, JR, SK and JM contributed to the design of the work, conception of ideas and development, testing and implementation of the QI project. MM wrote the first draft of the manuscript. All authors meaningfully contributed to revisions, have reviewed the final version and have provided permission to publish the manuscript. MM is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.