Improvement in Successful Extubation in Newborns After a Protocol-driven Approach: A Quality Improvement Initiative.

Objective: To reduce extubation failure rate by implementing protocol-driven ventilation and extubation strategies.

Methods: Quality improvement project in a level II neonatal care unit from April 2017 to January 2018. Ventilation and extubation protocols implemented from 1 August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act (PDCA) cycle I and 17 in PDCA cycle II. Primary outcome was extubation failure within the first 72 h of extubation.

Results: Extubation failure rate reduced from 41.7% (pre-protocol period) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to first extubation attempt significantly decreased (71.5 h to 38 h, P=0.046).

Conclusions: A protocolized approach through quality improvement initiative demonstrated a sustained improvement in successful extubation with a significant reduction in the median time to first extubation attempt in ventilated newborns.