Frequent extubation readiness assessments lower ICU length of stay
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Key takeaways:
- ICU patients spent less time in the ICU following adoption of twice-daily extubation readiness assessments.
- A subgroup of intubated patients also had reduced length of stay with assessments two times a day.
SAN DIEGO — Carrying out extubation readiness assessments twice a day lowered median ICU length of stay, according to research presented at the American Thoracic Society International Conference.
“[These findings] offer further real time clinical evidence of the benefit of wakefulness to patients in terms of optimization of weaning from the ventilator,” Julie-Kathryn Graham, PhD, APRN, ACCNS-AG, assistant professor at San Diego State University School of Nursing, told Healio.
“Despite the literature, many clinicians want to encourage rest (in the form of sedation), as conventionally, rest is associated with healing,” Graham continued. “However, the importance of using evidence to guide practice is underscored here. Optimal weaning improves functional status, prevents delirium and protects patients of potential harms of extended stays in acute care.”
In this study, Graham and colleagues evaluated adults admitted to a 38-bed medical ICU/surgical ICU to determine the impact adopting a once per 12-hour shift extubation readiness assessment has on ICU length of stay vs. a once-a-day extubation readiness assessment — a notion endorsed in the Society for Critical Care Medicine’s A2F bundle.
“A2F bundle rounding had been the standard in our ICU for quite some time,” Graham said. “With all the emerging and compelling literature pertaining to the perils of over-sedation and newer guidance for increased frequency of spontaneous breathing trials, our unit practice council took this on as a meaningful project.”
Researchers also studied the impact of twice-daily extubation readiness assessments on length of stay among intubated patients.
Compared with the median ICU length of stay 3 months prior to the adoption of twice-daily extubation readiness assessments, researchers found a 38% decrease in median length of stay at 3 months after adoption. The abstract notes that for each patient, this finding suggests a saving of over 24 hours.
Among intubated patients, adoption of once per 12-hour shift extubation readiness assessments contributed to a 20% reduction in median length of stay at 3 months (15 hours) vs. the median length of stay 3 months before adoption.
Despite changes in length of stay, mortality rates did not significantly change following adoption, according to researchers.
“Future studies should consider sustainability of practices such as this,” Graham told Healio. “A shared mental model of the benefit of the intervention among the interdisciplinary team is essential for consistency. This requires structures to be in place to support decision-making and accountability. Additionally, an organizational culture that supports transformational, collaborative, unit-driven change taps into the intellectual capital of all members of the team, providing opportunities for boundless innovation.”