Effect of a collaborative weaning plan on patient outcome in the critical care setting


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Abstract

ObjectiveThe process of weaning from mechanical ventilation can be complex, requiring collaborative care planning by members of the healthcare team. Improved outcomes have been demonstrated to result from collaborative decision-making processes (e.g., when ventilator teams were utilized). The purpose of this study was to evaluate the effect of a collaborative weaning plan (CWP) on length of time on mechanical ventilation, length of stay in the intensive care unit (ICU), and cost.DesignA new, collaborative weaning plan in the form of a weaning board and flowsheet was introduced into a medical intensive care unit (MICU) setting. A pre- and post-quasi-experimental design using historical controls was used to test the hypotheses. Attempts to control for the effects of history were made by collecting data related to patient, staffing, and organizational variables that could independently effect outcome.SettingMICU in a west coast teaching hospital.PatientsCritically ill patients receiving mechanical ventilation for 3 days or greater.InterventionImplementation of a collaborative weaning plan.MeasurementsOutcomes studied included length of stay in the MICU, length of time patients were mechanically ventilated in the MICU, cost per MICU stay, and the incidence of complications (e.g., reventilation, readmission to the ICU, and mortality rate.)Main ResultsThe CWP decreased length of stay in the MICU by 3.6 days (p = .03) and length of ventilator time by 2.7 days (p = .06). There were no significant differences between groups related to cost or incidence of complications.ConclusionsThese results support the usefulness of collaborative structures (such as weaning boards/flowsheets) in decreasing ICU length of stay.

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