title: Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: a prospective study.
abstract: OBJECTIVE
  To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation.
  
  
  METHODS
  Prospective study over a 9-month period.
  
  
  METHODS
  Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center.
  
  
  METHODS
  831 consecutive mechanically ventilated patients.
  
  
  METHODS
  CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients.
  
  
  RESULTS
  With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p = 0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively; p < 0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively; p = 0.92).
  
  
  CONCLUSIONS
  The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
authors.affiliation: Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China.
authors.forename: A A
authors.initials: AA
authors.lastname: Chiang
authors.forename: K C
authors.initials: KC
authors.lastname: Lee
authors.forename: J C
authors.initials: JC
authors.lastname: Lee
authors.forename: C H
authors.initials: CH
authors.lastname: Wei
mesh_terms: D003422:Critical Care / Q000592:standards; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000592:standards; D010348:Patient Care Team; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation / Q000706:statistics & numerical data*; D012307:Risk Factors; D017749:Total Quality Management