Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery: Erratum

Abstract

Objective-To determine whether a collaborative learning strategy derived clinical practice guideline (CPG) can reduce the duration of endotracheal intubation following infant heart surgery.Design-Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre-and post-CPG implementation at the four sites participating in the collaborative (active sites) compared to data from five PHN centers not participating in collaborative learning (control sites).Patients-Data were collected for infants following 2 index operations: 1) repair of isolated coarctation of the aorta (birth-365 days) and 2) repair of tetralogy of Fallot (29-365 days). There were 240 subjects eligible for the CPG at active sites and 259 subjects at control sites.Measurements and Main Results-After CPG implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p<0.001) with no increase in reintubation rate. The median duration of post-operative intubation among active sites decreased from 21.2 hours to 4.5 hours (p<.001). No statistically significant change in early extubation rates was found in the control sites 11.7% to 13.7% (p=0.63). At active sites CPG implementation had no statistically significant impact on median intensive care unit (ICU) length of stay (LOS) (71.9 hours pre-vs. 69.2 post-implementation, p=0.29) for the entire cohort. There was a trend toward shorter ICU LOS in the tetralogy of Fallot subgroup (71.6 hours pre-vs. 54.2 postimplementation, p=0.068).Conclusions-A collaborative learning strategy designed CPG significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation CPG did not significantly change post-operative ICU LOS. Keywords mechanical ventilation; tetralogy of Fallot; outcomesCollaborative learning is a technique based upon principles from the manufacturing industry designed to bring low-performing processes into line with the highest-performing processes. Collaborative learning involves several key steps including: 1) topic selection; 2) learning sessions; and 3) action periods in which teams test and implement changes in their local centers. Through benchmarking, locations with superior outcomes are identified. In the medical community, this is achieved by site visits, sharing protocols, and ongoing communication.Investigators have applied collaborative learning to improve results for coronary artery bypass graft surgery by creating a regional group willing to compare outcomes. 1 This voluntary program, which involved reciprocal site visits, was undertaken with the goal of exchanging information concerning the treatment of cardiovascular disease so that each participating institution would benefit. A similar strategy has been used by other adult cardiovascular consortia to improve outcomes following valve surgery. 2,3 Collaborative learning using site visits has not yet been applied to pediatric cardiac care and thus it is unknown if it can improve outcomes in pediatric cardiac su...