title: An interdisciplinary initiative to reduce unplanned extubations in pediatric critical care units.
abstract: OBJECTIVE
  Unplanned extubations in pediatric critical care units can result in increased mortality, morbidity, and length of stay. We sought to reduce the incidence of these events by reliably measuring occurrences and instituting a series of coordinated interdisciplinary interventions.
  
  
  METHODS
  This was an internal review board-approved quality improvement project. Data were prospectively collected from the electronic medical record, and analyzed over 24 months (January 1, 2009-December 2010), and divided into 3 periods: baseline (9 months), intervention with multiple rapid improvement cycles (8 months), and postintervention (7 months). Interventions included standardization of endotracheal tube taping practices upon admission, improved patient handoffs, systematic review of unplanned events, reexamination of sedation practices, and promotion of transparency of performance measures.
  
  
  RESULTS
  The PICU experienced 21 events in the 9 months before the initiative, 13 events over the 8-month intervention period, and 5 events in the 7-month postintervention period. The cardiac intensive care unit (CICU) experienced 11, 4, and 0 events, respectively. Mean event rates per 100 patient days for each interval were 0.80, 0.50, and 0.29 for the PICU and 0.74, 0.44, and 0 for the CICU. Monthly event rates for the CICU were significantly different by using the Kruskal-Wallis test (P < .05) but not for the PICU (P = .36)
  
  
  CONCLUSIONS
  Through accurate tracking, multiple practice changes, and promoting transparency of efforts and data, an interdisciplinary team reduced the number of unplanned extubations in both ICUs. This reduction has been sustained throughout the postintervention monitoring period.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, Colorado 80045, USA. kaufman.jonathan@tchden.org
authors.forename: Jon
authors.initials: J
authors.lastname: Kaufman
authors.forename: Michael
authors.initials: M
authors.lastname: Rannie
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kahn
authors.forename: Matthew
authors.initials: M
authors.lastname: Vitaska
authors.forename: Beth
authors.initials: B
authors.lastname: Wathen
authors.forename: Chris
authors.initials: C
authors.lastname: Peyton
authors.forename: Jerrold
authors.initials: J
authors.lastname: Judd
authors.forename: Zachary
authors.initials: Z
authors.lastname: Quinby
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: da Cruz
authors.forename: Emily
authors.initials: E
authors.lastname: Dobyns
mesh_terms: D028744:Ethics Committees, Research / Q000592:standards* / Q000639:trends; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000592:standards* / Q000639:trends; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000592:standards* / Q000639:trends; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors