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[Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit].

Abstract：

OBJECTIVE:To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). DESIGN:A prospective, comparative, longitudinal and interventional study was carried out. SETTING:The RICU of Hospital General de México (Mexico). PATIENTS:All patients admitted to the RICU from March 2012 to March 2013. INTERVENTIONS:An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP). VARIABLES OF INTEREST:NPE, reintubation and VAP ratios. RESULTS:A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5). CONCLUSIONS:Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements.

journal_name

Med Intensiva

journal_title

Medicina intensiva

authors

Álvarez Maldonado P,Cueto Robledo G,Cicero Sabido R

doi

10.1016/j.medin.2014.01.006

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

142-8

issue

3

eissn

0210-5691

issn

1578-6749

pii

S0210-5691(14)00038-2

journal_volume

39

pub_type

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