The Spillover Effects of Quality Improvement Beyond Target Populations in Mechanical Ventilation

• Published in: Critical care explorations 2022-11, Vol.4 (11), p.e0802-e0802
• Main Authors: Greenwald, Andrew S., Hauw-Berlemont, Caroline, Shan, Mingxu, Wang, Shuang, Yip, Natalie, Kurlansky, Paul, Argenziano, Michael, Bennett, Bridgette, Langone, Danielle, Moitra, Vivek
• Format: Article
• Language: English
• Subjects: Quality Improvement Report
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000000802

To assess the impact of a mechanical ventilation quality improvement program on patients who were excluded from the intervention. DESIGNBefore-during-and-after implementation interrupted time series analysis to assess the effect of the intervention between coronary artery bypass grafting (CABG) surgery patients (included) and left-sided valve surgery patients (excluded). SETTINGAcademic medical center. PATIENTSPatients undergoing CABG and left-sided valve procedures were analyzed. INTERVENTIONSA postoperative mechanical ventilation quality improvement program was developed for patients undergoing CABG. MEASUREMENTS AND MAIN RESULTSPatients undergoing CABG had a median mechanical ventilation time of 11 hours during P0 ("before" phase) and 6.22 hours during P2 ("after" phase; p < 0.001). A spillover effect was observed because mechanical ventilation times also decreased from 10 hours during P0 to 6 hours during P2 among valve patients who were excluded from the protocol (p < 0.001). The interrupted time series analysis demonstrated a significant level of change for ventilation time from P0 to P2 for both CABG (p < 0.0001) and valve patients (p < 0.0001). There was no significant difference in the slope of change between the CABG and valve patient populations across time cohorts (P0 vs P1 [p = 0.8809]; P1 vs P2 [p = 0.3834]; P0 vs P2 [p = 0.7672]), which suggests that the rate of change in mechanical ventilation times was similar between included and excluded patients. CONCLUSIONSDecreased mechanical ventilation times for patients who were not included in a protocol suggests a spillover effect of quality improvement and demonstrates that quality improvement can have benefits beyond a target population.