1354: IMPROVING COMPLIANCE TO SPONTANEOUS BREATHING TRIALS A SINGLE-CENTER EXPERIENCE

Abstract

Learning Objectives: The value of spontaneous breathing trials (SBT) is well-established. SBTs decrease duration of mechanical ventilation, which secondarily decreases risk of ventilatorassociated pneumonia and ICU length of stay. What is not well-established is how to improve adherence to these essential trials. Generally speaking, adherence to protocols in the ICU is low. Furthermore, perception of adherence often disagrees with reality. We attempted multiple modalities to improve adherence to SBTs at our tertiary academic institution. Methods: Baseline data was collected over 12 weeks. A total of 3 consecutive interventions were then conducted, resulting in 3 Plan-Do-Study-Act (PDSA) Cycles. Prior SAT and SBT documentation was paper-based. Thus, our 1st intervention was collaborating with nursing and respiratory therapy (RT) to integrate their documentation into the electronic medical record (EMR). As our 2nd intervention, we conducted weekly education sessions for nursing & RT on the importance of SAT and SBT. For our 3rd intervention, adherence data was recorded monthly and presented to nursing staffs and to individual RTs. Results: Baseline data: For all 716 ventilator days, 37% had documentation of SBT (or contraindication), while 22% underwent SBT. Following conversion of documentation from paper to EMR: SBT documentation increased to 78% and SBT performance increased to 32%. Following weekly education sessions: SBT documentation decreased to 67% and SBT performance decreased to 18%. Following reporting of adherence data to nursing staff & individual RTs: SBT documentation remained greater than 80% and 24% underwent SBTs. Conclusions: There is growing literature on the concept of implementation. Our single center experience, included 1077 ventilator days over 8 months and describes multiple approaches to change. Automation, computerization, and checklists are strong modes for healthcare implementation. The substantial increase observed after integration into the EMR supports these strategies. Conversely, education was an expectedly weak intervention in both response and sustainability. Transparency, although time consuming, continues to have sustainability on our follow-up. Data on ventilator-associated pneumonia, ventilator days, and ICU length of stay over this period is currently undergoing analysis.