Reducing Unplanned Intubations in the NICU After Children's Surgery | Single Center | Quality Improvement | Sep 2019 | Extubation readiness checklist | Post-op pain management guideline for NICU patients | Aimed to reduce post-op unplanned intubation events by 25% in one year. | Unplanned intubations in the NICU (events per patient) | 0.27 - pre-intervention group (Jan 2016-Aug 2019, n = 200) | 0.07 - post-intervention group (Sep 2019-Jun 2022, n = 145) | No difference between cohorts: | Post-op pneumonia rate (1.5% vs 0.0%, p = 0.267) | Median hospital length of stay [40 days vs 27, p = 0.124] | 30-day mortality rate for post-op patients in the NICU significantly declined [p < 0.001] | Conclusion: Emphasizing opioid stewardship and extubation readiness can decrease the rates of unplanned intubation after surgery in NICU patients. | https://pubmed.ncbi.nlm.nih.gov/37845122/ | Source: Juviler P et. al. | Department of Surgery, University of Rochester Medical Center, Rochester, NY | @EmGooteMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement Project
Infographic · Jun 2024 · 1 min read
In brief
In brief
Quality improvement initiative in a NICU reduced postoperative unplanned intubations by 76% through implementation of an extubation readiness checklist and non-opioid pain management protocol. The intervention also correlated with significantly decreased 30-day mortality without increasing pneumonia or length of stay.
- Extubation readiness checklist reduced unplanned NICU intubations by 76% (0.27 to 0.07 events per patient) after pediatric surgery.
- Shifting from opioids to non-opioid analgesics (acetaminophen) decreased respiratory depression without increasing pneumonia or length of stay.
- 30-day postoperative mortality in NICU patients dropped significantly from 6.5% to 0.7% following the intervention.
- Multidisciplinary case review identified modifiable causes: premature extubation and opioid-related respiratory depression.
- Quality improvement targeting high-risk populations (NICU surgical patients) can yield substantial safety gains within one year.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a hospital building illustration on the left, a downward trending graph in the center, and medical supply icons at the bottom. Red text highlights the key outcome metric, and a cartoon illustration of a healthcare provider with an infant appears in the lower right corner.
Peter Juviler, Jeffrey M. Meyers, Elizabeth Levatino, Jessica Axford, Erin Barker, Lynnie Correll, Andrew S. Decker, John Faria, Marjorie Gloff, Anthony Loria, Margo McKenna, Jan Schriefer, Timothy P. Stevens, Sarah Verna, Sarah Wegman, Kori Wolcott, Derek Wakeman
Background: Unplanned intubation following children's surgery is associated with increased postoperative mortality. In response to being a National Surgical Quality Improvement Program - Pediatric (NSQIP-P) high outlier for postoperative unplanned intubation, we aimed to reduce postoperative unplanned intubation events by 25% in one year.
Methods/Intervention: A multidisciplinary team of stakeholders was assembled in 2018. Most unplanned intubation events occurred in the neonatal intensive care unit (NICU). Based on apparent causes of unplanned intubations identified in case reviews, an extubation readiness checklist and a postoperative pain management guideline emphasizing non-opioid analgesics were implemented for NICU patients in September 2019. Postoperative unplanned intubation events were tracked prospectively and evaluated using quality improvement statistical process control methods.
Results: Unplanned intubations in the NICU decreased from 0.27 to 0.07 events per patient in the post-intervention group (September 2019–June 2022, n = 145) compared to the pre-intervention group (January 2016–August 2019, n = 200), representing a 76% reduction. Postoperative opioid administration decreased significantly, while acetaminophen usage increased significantly over time. Balancing measures of postoperative pneumonia rate (1.5% vs 0.0%, p = 0.267) and median hospital length of stay [40 (IQR 51) days vs 27 (IQR 60), p = 0.124] were not different between cohorts. The 30-day mortality rate for postoperative patients in the NICU significantly declined [6.5% (n = 13) vs 0.7% (n = 1), p < 0.001].
Conclusions: Postoperative unplanned intubation rates for NICU patients decreased following a quality improvement effort focused on opioid stewardship and extubation readiness.