• Jennifer L Hefner, Ravi S Tripathi, Erik E Abel, Michelle Farneman, Jason Galloway, and Susan D Moffatt-Bruce.
• Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center. Jennifer.Hefner@osumc.edu.
• Am. J. Crit. Care. 2016 Sep 1; 25 (5): 423-30.

BackgroundIn 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%.ObjectivesTo use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time.MethodsA multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record. Outcomes of mechanical ventilation in CABG patients before and after the interventions are compared.ResultsAll target outcomes changed significantly after the interventions, including a reduction in the median hours of initial mechanical ventilation (from 11.4 hours to 6.9 hours, P < .001). The percentage of patients reintubated did not increase (a decrease from 11.8% to 3.5% was not significant, P = .08). The rate of prolonged ventilation decreased from 29.4% to 8.6% (P = .004), and this reduction was sustained for 4 years after the interventions.ConclusionsSuccess factors included the multidisciplinary task force and continual protocol reeducation among front-line staff.©2016 American Association of Critical-Care Nurses.

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