Objective
Ventilator-associated events (VAE) are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the NIH and AHRQ funded a two-state collaborative to reduce VAEs. We describe the collaborative’s impact on VAE rates in 56 ICUs.
Design
Longitudinal quasi-experimental study.
Setting
56 intensive care units (ICUs) at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015.
Interventions
We organized a multifaceted intervention to improve adherence with evidence-based practices, unit teamwork and safety culture. Evidence-based interventions promoted by the collaborative included head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care, and daily spontaneous awakening and breathing trials. Each unit established a multi-disciplinary quality improvement team. We coached teams to establish comprehensive unit-based safety programs through monthly teleconferences. Data were collected on rounds using a common tool and entered into a web-based portal.
Measurements and Results
ICUs reported 69,417 ventilated patient-days of intervention compliance observations and 1,022 unit-months of VAE data. Compliance with all evidence-based interventions improved over the course of the collaborative. The quarterly mean VAE rate significantly decreased from 7.34 to 4.58 cases per 1,000 ventilator-days after 24 months of implementation (p=0.007). During the same time period, infection-related ventilator-associated complication (IVAC) and possible and probable ventilator-associated pneumonia (PVAP) rates decreased from 3.15 to 1.56 and 1.41 to 0.31 cases per 1,000 ventilator-days (p=0.018, p=0.012), respectively.
Conclusions
A multifaceted intervention was associated with improved compliance with evidence-based interventions and decreases in VAE, IVAC and PVAP. Our study is the largest to date affirming that best practices can prevent VAEs.