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Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department
INTRODUCTION: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MSU College of Osteopathic Medicine Statewide Campus System
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873436/ https://www.ncbi.nlm.nih.gov/pubmed/35291703 http://dx.doi.org/10.51894/001c.29603 |
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author | Heimberg, David H. Illg, Zachary Corser, William D. |
author_facet | Heimberg, David H. Illg, Zachary Corser, William D. |
author_sort | Heimberg, David H. |
collection | PubMed |
description | INTRODUCTION: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates. METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients’ heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions. RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01). CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders. |
format | Online Article Text |
id | pubmed-8873436 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MSU College of Osteopathic Medicine Statewide Campus System |
record_format | MEDLINE/PubMed |
spelling | pubmed-88734362022-03-14 Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department Heimberg, David H. Illg, Zachary Corser, William D. Spartan Med Res J Quality Improvement/Patient Safety INTRODUCTION: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates. METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients’ heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions. RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01). CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders. MSU College of Osteopathic Medicine Statewide Campus System 2022-02-24 /pmc/articles/PMC8873436/ /pubmed/35291703 http://dx.doi.org/10.51894/001c.29603 Text en https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Quality Improvement/Patient Safety Heimberg, David H. Illg, Zachary Corser, William D. Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title | Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title_full | Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title_fullStr | Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title_full_unstemmed | Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title_short | Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department |
title_sort | quality improvement intervention associated with improved lung protective ventilation settings in an emergency department |
topic | Quality Improvement/Patient Safety |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873436/ https://www.ncbi.nlm.nih.gov/pubmed/35291703 http://dx.doi.org/10.51894/001c.29603 |
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