Advancing Extubation Time for Cardiac Surgery Patients Using Lean Work Design

Background Early extubation in select cardiac surgery patients reduces tracheal intubation times, intensive care unit length of stay, and hospital length of stay. While there is good evidence in the literature to support early extubation, there is very little published research that describes how to...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2014-12, Vol.28 (6), p.1490-1496
Main Authors: Gutsche, Jacob T., MD, Erickson, Lee, MD, Ghadimi, Kamrouz, MD, Augoustides, John G., MD, FACE, FAHA, Dimartino, Joseph, RN, Szeto, Wilson Y., MD, Ochroch, E. Andrew, MD
Format: Article
Language:English
Subjects:
Aged
Airway Extubation - methods
Airway Extubation - statistics & numerical data
Anesthesia & Perioperative Care
aortic valve replacement
Cardiac Surgical Procedures
coronary artery bypass graft
Critical Care
early extubation
extubation
Female
Humans
lean design
Length of Stay - statistics & numerical data
Male
Middle Aged
mitral valve replacement
Postoperative Period
Practice Guidelines as Topic
quality improvement
Retrospective Studies
Time Factors
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Summary:Background Early extubation in select cardiac surgery patients reduces tracheal intubation times, intensive care unit length of stay, and hospital length of stay. While there is good evidence in the literature to support early extubation, there is very little published research that describes how to study and redesign processes of care to increase early extubation rates. Objective To improve rates of early extubation by redesigning patient care processes using Lean principles to remove barriers to desired care and facilitate early extubation with guideline management. Design Retrospective data analysis. Setting Sixteen-bed intensive care unit in a mid-sized, academic community hospital. Patients Four hundred four patients undergoing coronary artery bypass graft surgery, aortic valve replacement, or mitral valve replacement/repair. Intervention The process of care for cardiac surgery patients, beginning with the immediate preoperative period and ending with extubation in the postoperative period, was analyzed using Lean methodologies. A value stream analysis was performed to identify waste in the process, and root causes for the largest sources of waste were identified. Hypothermia on admission to the intensive care unit, prolonged weaning using arterial blood gas results, hypertension management with pain medications and sedation medications, and delays in obtaining equipment were the primary reasons early extubation was delayed. Process redesign using Lean work design principles was implemented to eliminate these issues. Measurements The rate of patients being extubated in fewer than 6 hours and length of intubation. Results One hundred ninety-five pre-intervention subjects were compared with 171 post-intervention subjects. The pre- and post- groups did not differ in demographic predictors ( Table 1 ). The intervention predicted extubation in
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2014.05.024