Guillermo Cueto Robledo

Cambios en tres indicadores de calidad después de la implementación de estrategias de mejora en la unidad de cuidados intensivos respiratorios

OBJECTIVE To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). DESIGN A prospective, comparative, longitudinal and interventional study was carried out. SETTING The RICU of Hospital General de México (Mexico). PATIENTS All patients admitted to the RICU from March 2012 to March 2013. INTERVENTIONS An 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 INTEREST NPE, reintubation and VAP ratios. RESULTS A 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). CONCLUSIONS Quality 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.