Variation in Implementation and Outcomes of Early Extubation Practices After Infant Cardiac Surgery. Bates, K. E., Mahle, W. T., Bush, L., Donohue, J., Gaies, M. G., Nicolson, S. C., Shekerdemian, L., Witte, M., Wolf, M., Shea, J. A., Likosky, D. S., & Pasquali, S. K. The Annals of Thoracic Surgery, 107(5):1434–1440, 2019. doi abstract bibtex BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation after infant tetralogy of Fallot (TOF) and coarctation repair overall at participating sites through implementing a clinical practice guideline (CPG). We evaluated variability across sites in CPG implementation and outcomes. METHODS: Patient characteristics and outcomes (time to extubation, length of stay [LOS]) were compared across sites, including pre-CPB to post-CPG changes. Semistructured interviews were analyzed to assess similarities and differences in implementation strategies across sites. RESULTS: A total of 322 patients were included (4 active sites, 1 model site). Patient characteristics were similar across active sites, whereas pre-CPG median time to extubation varied from 15.4 to 35.5 hours. All active sites had a significant post-CPG decline (p \textless 0.001); however, there was variation in the post-CPG median time to extubation (0.3 to 5.3 hours, p = 0.01) and magnitude of change (-73.3% to -99.2%). Site A achieved the shortest post-CPG time to extubation and had the greatest percentage change. Two sites had significant decreases in medical ICU LOS in TOF patients; no hospital LOS changes were seen. All sites valued the collaborative learning strategy, site visits, CPG flexibility, and had similar core team composition. Site A used several unique strategies: inclusion of other staff and fellows, regular in-person data reviews, additional data collection, and creation of complementary protocols. CONCLUSIONS: All PHN CLS sites successfully reduced time to extubation. The magnitude of change varied and may be partly explained by different CPG implementation strategies. These data can guide CPG dissemination and design of future improvement projects.
@article{bates_variation_2019,
title = {Variation in {Implementation} and {Outcomes} of {Early} {Extubation} {Practices} {After} {Infant} {Cardiac} {Surgery}},
volume = {107},
issn = {1552-6259},
doi = {10.1016/j.athoracsur.2018.11.031},
abstract = {BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation after infant tetralogy of Fallot (TOF) and coarctation repair overall at participating sites through implementing a clinical practice guideline (CPG). We evaluated variability across sites in CPG implementation and outcomes.
METHODS: Patient characteristics and outcomes (time to extubation, length of stay [LOS]) were compared across sites, including pre-CPB to post-CPG changes. Semistructured interviews were analyzed to assess similarities and differences in implementation strategies across sites.
RESULTS: A total of 322 patients were included (4 active sites, 1 model site). Patient characteristics were similar across active sites, whereas pre-CPG median time to extubation varied from 15.4 to 35.5 hours. All active sites had a significant post-CPG decline (p {\textless} 0.001); however, there was variation in the post-CPG median time to extubation (0.3 to 5.3 hours, p = 0.01) and magnitude of change (-73.3\% to -99.2\%). Site A achieved the shortest post-CPG time to extubation and had the greatest percentage change. Two sites had significant decreases in medical ICU LOS in TOF patients; no hospital LOS changes were seen. All sites valued the collaborative learning strategy, site visits, CPG flexibility, and had similar core team composition. Site A used several unique strategies: inclusion of other staff and fellows, regular in-person data reviews, additional data collection, and creation of complementary protocols.
CONCLUSIONS: All PHN CLS sites successfully reduced time to extubation. The magnitude of change varied and may be partly explained by different CPG implementation strategies. These data can guide CPG dissemination and design of future improvement projects.},
language = {eng},
number = {5},
journal = {The Annals of Thoracic Surgery},
author = {Bates, Katherine E. and Mahle, William T. and Bush, Lauren and Donohue, Janet and Gaies, Michael G. and Nicolson, Susan C. and Shekerdemian, Lara and Witte, Madolin and Wolf, Michael and Shea, Judy A. and Likosky, Donald S. and Pasquali, Sara K.},
year = {2019},
pmid = {30557537},
pmcid = {PMC6687063},
keywords = {Airway Extubation, Aortic Coarctation, Cardiac Surgical Procedures, Clinical Protocols, Cohort Studies, Female, Guideline Adherence, Humans, Infant, Infant, Newborn, Length of Stay, Male, Postoperative Care, Practice Patterns, Physicians', Tetralogy of Fallot, Time Factors, Treatment Outcome},
pages = {1434--1440}
}
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{"_id":"iqknDs5XHitQQdfm8","bibbaseid":"bates-mahle-bush-donohue-gaies-nicolson-shekerdemian-witte-etal-variationinimplementationandoutcomesofearlyextubationpracticesafterinfantcardiacsurgery-2019","authorIDs":[],"author_short":["Bates, K. E.","Mahle, W. T.","Bush, L.","Donohue, J.","Gaies, M. G.","Nicolson, S. C.","Shekerdemian, L.","Witte, M.","Wolf, M.","Shea, J. A.","Likosky, D. S.","Pasquali, S. K."],"bibdata":{"bibtype":"article","type":"article","title":"Variation in Implementation and Outcomes of Early Extubation Practices After Infant Cardiac Surgery","volume":"107","issn":"1552-6259","doi":"10.1016/j.athoracsur.2018.11.031","abstract":"BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation after infant tetralogy of Fallot (TOF) and coarctation repair overall at participating sites through implementing a clinical practice guideline (CPG). We evaluated variability across sites in CPG implementation and outcomes. METHODS: Patient characteristics and outcomes (time to extubation, length of stay [LOS]) were compared across sites, including pre-CPB to post-CPG changes. Semistructured interviews were analyzed to assess similarities and differences in implementation strategies across sites. RESULTS: A total of 322 patients were included (4 active sites, 1 model site). Patient characteristics were similar across active sites, whereas pre-CPG median time to extubation varied from 15.4 to 35.5 hours. All active sites had a significant post-CPG decline (p \\textless 0.001); however, there was variation in the post-CPG median time to extubation (0.3 to 5.3 hours, p = 0.01) and magnitude of change (-73.3% to -99.2%). Site A achieved the shortest post-CPG time to extubation and had the greatest percentage change. Two sites had significant decreases in medical ICU LOS in TOF patients; no hospital LOS changes were seen. All sites valued the collaborative learning strategy, site visits, CPG flexibility, and had similar core team composition. Site A used several unique strategies: inclusion of other staff and fellows, regular in-person data reviews, additional data collection, and creation of complementary protocols. CONCLUSIONS: All PHN CLS sites successfully reduced time to extubation. The magnitude of change varied and may be partly explained by different CPG implementation strategies. These data can guide CPG dissemination and design of future improvement projects.","language":"eng","number":"5","journal":"The Annals of Thoracic Surgery","author":[{"propositions":[],"lastnames":["Bates"],"firstnames":["Katherine","E."],"suffixes":[]},{"propositions":[],"lastnames":["Mahle"],"firstnames":["William","T."],"suffixes":[]},{"propositions":[],"lastnames":["Bush"],"firstnames":["Lauren"],"suffixes":[]},{"propositions":[],"lastnames":["Donohue"],"firstnames":["Janet"],"suffixes":[]},{"propositions":[],"lastnames":["Gaies"],"firstnames":["Michael","G."],"suffixes":[]},{"propositions":[],"lastnames":["Nicolson"],"firstnames":["Susan","C."],"suffixes":[]},{"propositions":[],"lastnames":["Shekerdemian"],"firstnames":["Lara"],"suffixes":[]},{"propositions":[],"lastnames":["Witte"],"firstnames":["Madolin"],"suffixes":[]},{"propositions":[],"lastnames":["Wolf"],"firstnames":["Michael"],"suffixes":[]},{"propositions":[],"lastnames":["Shea"],"firstnames":["Judy","A."],"suffixes":[]},{"propositions":[],"lastnames":["Likosky"],"firstnames":["Donald","S."],"suffixes":[]},{"propositions":[],"lastnames":["Pasquali"],"firstnames":["Sara","K."],"suffixes":[]}],"year":"2019","pmid":"30557537","pmcid":"PMC6687063","keywords":"Airway Extubation, Aortic Coarctation, Cardiac Surgical Procedures, Clinical Protocols, Cohort Studies, Female, Guideline Adherence, Humans, Infant, Infant, Newborn, Length of Stay, Male, Postoperative Care, Practice Patterns, Physicians', Tetralogy of Fallot, Time Factors, Treatment Outcome","pages":"1434–1440","bibtex":"@article{bates_variation_2019,\n\ttitle = {Variation in {Implementation} and {Outcomes} of {Early} {Extubation} {Practices} {After} {Infant} {Cardiac} {Surgery}},\n\tvolume = {107},\n\tissn = {1552-6259},\n\tdoi = {10.1016/j.athoracsur.2018.11.031},\n\tabstract = {BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation after infant tetralogy of Fallot (TOF) and coarctation repair overall at participating sites through implementing a clinical practice guideline (CPG). We evaluated variability across sites in CPG implementation and outcomes.\nMETHODS: Patient characteristics and outcomes (time to extubation, length of stay [LOS]) were compared across sites, including pre-CPB to post-CPG changes. Semistructured interviews were analyzed to assess similarities and differences in implementation strategies across sites.\nRESULTS: A total of 322 patients were included (4 active sites, 1 model site). Patient characteristics were similar across active sites, whereas pre-CPG median time to extubation varied from 15.4 to 35.5 hours. All active sites had a significant post-CPG decline (p {\\textless} 0.001); however, there was variation in the post-CPG median time to extubation (0.3 to 5.3 hours, p = 0.01) and magnitude of change (-73.3\\% to -99.2\\%). Site A achieved the shortest post-CPG time to extubation and had the greatest percentage change. Two sites had significant decreases in medical ICU LOS in TOF patients; no hospital LOS changes were seen. All sites valued the collaborative learning strategy, site visits, CPG flexibility, and had similar core team composition. Site A used several unique strategies: inclusion of other staff and fellows, regular in-person data reviews, additional data collection, and creation of complementary protocols.\nCONCLUSIONS: All PHN CLS sites successfully reduced time to extubation. The magnitude of change varied and may be partly explained by different CPG implementation strategies. These data can guide CPG dissemination and design of future improvement projects.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {The Annals of Thoracic Surgery},\n\tauthor = {Bates, Katherine E. and Mahle, William T. and Bush, Lauren and Donohue, Janet and Gaies, Michael G. and Nicolson, Susan C. and Shekerdemian, Lara and Witte, Madolin and Wolf, Michael and Shea, Judy A. and Likosky, Donald S. and Pasquali, Sara K.},\n\tyear = {2019},\n\tpmid = {30557537},\n\tpmcid = {PMC6687063},\n\tkeywords = {Airway Extubation, Aortic Coarctation, Cardiac Surgical Procedures, Clinical Protocols, Cohort Studies, Female, Guideline Adherence, Humans, Infant, Infant, Newborn, Length of Stay, Male, Postoperative Care, Practice Patterns, Physicians', Tetralogy of Fallot, Time Factors, Treatment Outcome},\n\tpages = {1434--1440}\n}\n\n","author_short":["Bates, K. E.","Mahle, W. T.","Bush, L.","Donohue, J.","Gaies, M. G.","Nicolson, S. C.","Shekerdemian, L.","Witte, M.","Wolf, M.","Shea, J. 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