Success factors and hurdles in quality improvement in a children's hospital.
A set of nurse/respiratory therapist-driven algorithms developed by a multidisciplinary team with the goal of "liberating" mechanically ventilated pediatric patients more rapidly from the ventilator resulted in sustained improvement over a 47-month period. The difference between expected and observed billed ventilator hour totals was over 22,000 hours (475 hours per month), a 17.5% reduction, which was significant at the P =.03 level by multiple linear regression analysis. Length of stay and mortality rate were unchanged. This difference represents a measure of the unrecognized cost of a nonstandardized approach to the weaning process. This reports reviews this team's success factors and hurdles and offers practical suggestions for pediatric surgeons interested in leading quality improvement initiatives.
Smith
C D
CD
Medical University Hospital Authority, Charleston, SC, USA.
Tecklenburg
Fred W
FW
Habib
David M
DM
Hughes
Mary R
MR
Hulsey
Thomas C
TC
Ebeling
Myla
M
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008297:Male; D012044:Regression Analysis; D013022:South Carolina; D018709:Statistics, Nonparametric; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods*; D015300:Ventilator Weaning