title: [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).
  
  
  METHODS
  A prospective, comparative, longitudinal and interventional study was carried out.
  
  
  METHODS
  The RICU of Hospital General de México (Mexico).
  
  
  METHODS
  All patients admitted to the RICU from March 2012 to March 2013.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Unidad de Cuidados Intensivos Respiratorios, Servicio de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", México, D.F., México. Electronic address: pamyacs@yahoo.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: Álvarez Maldonado
authors.affiliation: Unidad de Cuidados Intensivos Respiratorios, Servicio de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", México, D.F., México.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cueto Robledo
authors.affiliation: Unidad de Cuidados Intensivos Respiratorios, Servicio de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", México, D.F., México.
authors.forename: Raúl
authors.initials: R
authors.lastname: Cicero Sabido
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012121:Respiration, Artificial; D012138:Respiratory Therapy; D012720:Severity of Illness Index
keywords: Cuidado de la salud; Health care; Indicadores de calidad; Intensive care units; Mejora de la calidad; Quality improvement; Quality indicators; Unidad de cuidados intensivos