Fast Track Extubation In Recovery of Open Heart Patients

Purpose:
Best practice for intubation times during recovery of post-op open heart patients is less than six (6) hours. Our CICU looked at our data and realized only 33% of our patients met this goal (national average is 39%). We set a goal to be better than the national average for this measurement.

Significance:
Increased intubation times in this patient popluation can increase morbidity and mortality, including but not limited to ventilator associated pneumonia. Decreasing intubation times has been shown to decrease the liklihood of having post-op complications.

Strategy and Implementation:
Achieving this goal required teamwork and good communication from all members of the health care team - including RNs, Respiratory Therapists, Anesthesiologists, and physicians. A team representing all these members began meeting weekly to discuss barriers and to review the data. Communication between the different members of the team dramatically increased as the common goal began to gain momentum. The team leaders met with staff to ensure that all members of the team were educated and compliant with the goal. One tool that was developed by the RNs in the CICU was the posting of goal extubation times in the patient room upon arrival to the unit in order to maintain a visual reminder of the team's goal. Also, the "Fastest RN in the CICU" was posted in the unit with the names of those nurses with the shortest extubation times. This increased morale by creating a fun and competitive spirit to engage staff in reaching our goal.

Evaluation:
The average percentage of post-op open heart surgery patients that are recovered off the ventilator within six hours has increased from an 33% to now 57%, with one month being as high as 71%. We also decreased restraint usage and increased nursing satisfaction on our NDNQI survey as a result.

Implications for Practice:
The improvements made have been sustained by the team for the last several months. Using teamwork, accountability, and best practice for making improvement in patient care has been a great accomplishiment for this team.