Resident-Championed Quality Improvement Provides Value: Confronting Prolonged Mechanical Ventilation.

Autor: Malek AJ; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Isbell CL; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Mrdutt MM; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Zamin SA; Texas A&M Health Science Center, College of Medicine, Temple, Texas., Allen EM; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Coulson SE; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Regner JL; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas., Papaconstantinou HT; Department of Surgery, Baylor Scott & White Health, Texas A&M, Temple, Texas. Electronic address: harry.papaconstantinou@bswhealth.org.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2020 Dec; Vol. 256, pp. 36-42. Date of Electronic Publication: 2020 Jul 16.
DOI: 10.1016/j.jss.2020.06.012
Abstrakt: Background: The Quality In-Training Initiative (QITI) provides hands-on quality improvement education for residents. As our institution has ranked in the bottom quartile for prolonged mechanical ventilation (PMV) according to the National Surgical Quality Improvement Program (NSQIP), we sought to illustrate how our resident-led QITI could be used to determine perioperative contributors to PMV.
Materials and Methods: The Model for Improvement framework (developed by Associates in Process Improvement) was used to target postoperative ventilator management. However, baseline findings from our 2016 NSQIP data suggested that preoperative patient factors were more likely contributing to PMV. Subsequently, a retrospective one-to-one case-control study was developed, comparing preoperative NSQIP risk calculator profiles for PMV patients to case-matched patients for age, sex, procedure, and emergent case status. Chart review determined ventilator time, 30-d outcomes, and all-cause mortality.
Results: Forty-five patients with PMV (69% elective) had a median ventilator time of 134 h (interquartile range 87-254). The NSQIP calculator demonstrated increased preoperative risk percentages in PMV patients when compared to case-matched patients for any complication (includes PMV), predicted length of stay, and death (all P < 0.05). Thirty-day outcomes were worse for the PMV group in categories for sepsis, pneumonia, unplanned reoperation, 30-d mortality, rehab facility discharge, and length of stay (all P < 0.05). All-cause mortality was also significantly higher for PMV patients (P < 0.05).
Conclusions: Resident-led QITI projects enhance resident education while exposing opportunities for improving care. Preoperative patient factors play a larger-than-anticipated role in PMV at our institution. Ongoing efforts are aimed toward preoperative identification and optimization of high-risk patients.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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