Importance
Pediatric laryngotracheal reconstruction (LTR) remains the standard surgical technique for expanding a stenotic airway and necessitates a multidisciplinary team. Sedation wean following LTR is a critical component of perioperative care. We identified variation and communications deficiencies with our sedation wean practice and describe our experience implementing a standardized sedation wean protocol.
Objective
Standardize and decrease length of sedation wean in pediatric patients undergoing LTR.
Design
Using Institute for Healthcare Improvement (IHI) methodology, we implemented system-wide change with the goal of improving care based on best practice guidelines. We created a standardized electronic sedation wean communication document and retrospectively examined our experience in 29 consecutive patients who underwent LTR before (n=16, pre-wean group) and after (n=13, post-wean group) wean document implementation.
Setting
Tertiary care center
Participants
Pediatric patients undergoing LTR
Intervention
Implement standardized sedation protocol
Main Outcomes
Presence of sedation wean document in electronic medical record, length of sedation wean, and need for continued wean after discharge
Results
The sedation wean document was utilized in 92.3% patients of the post-wean group. With the new process, the mean length of sedation wean was reduced from 16.19 (standard deviation [SD] 11.56) days in pre-wean group to 8.92 (SD 3.37) days in the post-wean group, p<0.05. Fewer patients in the post-wean group required continued wean after discharge, 81.3% vs. 33.3%, p<0.05.
Conclusions and Relevance
We implemented system-wide process change with the goal of improving care based on best practice guidelines, which significantly decreased the time required for sedation wean following LTR. Our methodological approach may have implications for other heterogeneous patient populations requiring a sedation wean.