“Plan A”

Project By-line: Improving Early Extubation for Eligible Patients Following Cardiothoracic Surgery

Introduction Paragraph:   Prolonged mechanical ventilation is associated with increased hospital and intensive care unit (ICU) lengths of stay, higher health care costs, and increased morbidity resulting from atelectasis, intrapulmonary shunting, and pneumonia. In contrast, early extubation of postoperative heart surgery patients has been associated with shorter ICU and overall hospital stays and decreased resource use.  Early extubation, defined by the Society for Thoracic Surgeons (STS) as > 6 hours) has been shown to be safe and effective even in elderly patients, with no increased risk of reintubation. Despite this knowledge, our CTICU did not use an established protocol for promoting early extubation in postoperative heart surgery patients.

Primary Aim:  To assess the effectiveness of implementing a standardized, evidence-based protocol for decreasing postoperative mechanical ventilation time to < 6 hours.

 Design: This study is a 3-cycle quality improvement design, with 2 cycles of baseline observation followed by implementation of an evidence-based practice protocol for early extubation, and ending with a 3^rd cycle of observed practice change.

 Metrics:   Extubation time for patients meeting criteria for “Plan A” (early extubation) after admission to ICU following cardiothoracic surgery.

 Timeline: 3 months pre; 3 months post protocol implementation

Project Team Lead: Myra Ellis, RN, MSN (myra.ellis@duke.edu)