• Medicina intensiva · Apr 2015

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

    • Pablo Álvarez Maldonado, Guillermo Cueto Robledo, and Raúl Cicero Sabido.
    • Unidad de Cuidados Intensivos Respiratorios, Servicio de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", México, D.F., México. Electronic address: pamyacs@yahoo.com.
    • Med Intensiva. 2015 Apr 1; 39 (3): 142-8.

    ObjectiveTo compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU).DesignA prospective, comparative, longitudinal and interventional study was carried out.SettingThe RICU of Hospital General de México (Mexico).PatientsAll patients admitted to the RICU from March 2012 to March 2013.InterventionsAn 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).Variables Of InterestNPE, reintubation and VAP ratios.ResultsA 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).ConclusionsQuality 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.Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

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