Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit

• Published in: Medicina intensiva Vol. 39; no. 3; p. 142
• Main Authors: Álvarez Maldonado, Pablo, Cueto Robledo, Guillermo, Cicero Sabido, Raúl
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.04.2015
• Subjects: Adult; Aged; Female; Hospital Mortality; Humans; Intensive Care Units - standards; Intubation, Intratracheal; Length of Stay; Male; Middle Aged; Prospective Studies; Quality Improvement; Quality Indicators, Health Care; Respiration, Artificial; Respiratory Therapy; Severity of Illness Index; Health care; Intensive care units; Quality improvement; Quality indicators; Cuidado de la salud; Indicadores de calidad; Unidad de cuidados intensivos; Mejora de la calidad
• ISSN: 1578-6749
• DOI: 10.1016/j.medin.2014.01.006

To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). A prospective, comparative, longitudinal and interventional study was carried out. The RICU of Hospital General de México (Mexico). All patients admitted to the RICU from March 2012 to March 2013. 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). NPE, reintubation and VAP ratios. 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). 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.