title: Systemwide change of sedation wean protocol following pediatric laryngotracheal reconstruction.
abstract: OBJECTIVE
  Pediatric laryngotracheal reconstruction (LTR) remains the standard surgical technique for expanding a stenotic airway and necessitates a multidisciplinary team. Sedation wean following LTR is a critical component of perioperative care. We identified variation and communications deficiencies with our sedation wean practice and describe our experience implementing a standardized sedation wean protocol.
  
  
  OBJECTIVE
  To standardize and decrease length of sedation wean in pediatric patients undergoing LTR.
  
  
  METHODS
  Using Institute for Healthcare Improvement (IHI) methodology, we implemented systemwide change at a tertiary care center with the goal of improving care based on best practice guidelines. We created a standardized electronic sedation wean communication document and retrospectively examined our experience in 29 consecutive patients who underwent LTR before (n = 16, prewean group) and after (n = 13, postwean group) wean document implementation.
  
  
  METHODS
  Implementation of a standardized sedation protocol.
  
  
  METHODS
  Presence of sedation wean document in the electronic medical record, length of sedation wean, and need for continued wean after discharge.
  
  
  RESULTS
  The sedation wean document was used in 92.3% patients in the postwean group. With the new process, the mean (SD) length of sedation wean was reduced from 16.19 (11.56) days in the prewean group to 8.92 (3.37) days in the postwean group (P = .045). Fewer patients in the postwean group required continued wean after discharge (81.3% vs 33.3%; P = .02).
  
  
  CONCLUSIONS
  We implemented a systemwide process change with the goal of improving care based on best practice guidelines, which significantly decreased the time required for sedation wean following LTR. Our methodological approach may have implications for other heterogeneous patient populations requiring a sedation wean.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cummings
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rogers
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Brian
authors.initials: B
authors.lastname: Lin
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rosh
authors.initials: R
authors.lastname: Sethi
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston.
authors.forename: Natan
authors.initials: N
authors.lastname: Noviski
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D002675:Child, Preschool; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome