Effect of a collaborative weaning plan on patient outcome in the critical care setting.
OBJECTIVE
The process of weaning from mechanical ventilation can be complex, requiring collaborative care planning by members of the healthcare team. Improved outcomes have been demonstrated to result from collaborative decision-making processes (e.g., when ventilator teams were utilized). The purpose of this study was to evaluate the effect of a collaborative weaning plan (CWP) on length of time on mechanical ventilation, length of stay in the intensive care unit (ICU), and cost.


METHODS
A new, collaborative weaning plan in the form of a weaning board and flowsheet was introduced into a medical intensive care unit (MICU) setting. A pre- and post-quasi-experimental design using historical controls was used to test the hypotheses. Attempts to control for the effects of history were made by collecting data related to patient, staffing, and organizational variables that could independently effect outcome.


METHODS
MICU in a west coast teaching hospital.


METHODS
Critically ill patients receiving mechanical ventilation for 3 days or greater.


METHODS
Implementation of a collaborative weaning plan.


METHODS
Outcomes studied included length of stay in the MICU, length of time patients were mechanically ventilated in the MICU, cost per MICU stay, and the incidence of complications (e.g., reventilation, readmission to the ICU, and mortality rate).


RESULTS
The CWP decreased length of stay in the MICU by 3.6 days (p =.03) and length of ventilator time by 2.7 days (p =.06). There were no significant differences between groups related to cost or incidence of complications.


CONCLUSIONS
These results support the usefulness of collaborative structures (such as weaning boards/flowsheets) in decreasing ICU length of stay.
UCLA Medical Center and the UCLA School of Nursing, Los Angeles, CA, USA.
E
E
Henneman
K
K
Dracup
T
T
Ganz
O
O
Molayeme
C
C
Cooper
D018806:APACHE; D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003422:Critical Care / Q000458:organization & administration*; D003659:Decision Making, Organizational; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000191:economics / Q000379:methods*