Impact of respiratory therapists-driven assess-and-treat protocol on unplanned adult neurovascular ICU readmissions: a quality improvement initiative

[摘要] ICU readmission is associated with increased mortality, resource utilisation and hospital expenditure. In the general population, respiratory-related event is one of the most common causes of unexpected ICU readmission. Patients with neurological deficits faced an increased risks of ICU readmissions due to impaired mentation, protective reflexes and other factors. A retrospective review revealed that the leading cause of unexpected ICU readmissions in adult neurovascular patients admitted to our hospital was respiratory related. A respiratory therapists-driven assessment-and-treat protocol was developed for proactively assessing and treating adult neurovascular patients. On-duty respiratory therapists assessed all neurovascular patients on admission, assigned a respiratory severity score to each patient and then recommended interventions based on a standardised algorithm.Our quality improvement initiative had no effect on the rate of unexpected ICU readmissions in adult neurovascular patients. When compared with the baseline population, patients enrolled in the intervention group were significantly older ((79, 68–85 years) vs (71, 56–81 years)), but they spent comparable amount of time in the ICU (4.5 vs 4 days, p=0.42). When the respiratory severity score was trended in the intervention group, patients demonstrated significant improvement in their respiratory function, with a greater proportion of patients scoring in the minimal and mild categories and smaller proportion in the moderate category (p<0.01).Critical careQuality improvementImplementation sciencePatient-centred careData availability statementData are available on reasonable request.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

[学科分类] 药学

[关键词] Critical care;Quality improvement;Implementation science;Patient-centred care