Background Spontaneous awakening and breathing trials are evidence based; however, adoption has been inconsistent. Local Problem An academic medical center demonstrated a need for investigating and quantifying practice patterns regarding spontaneous awakening and breathing trials. Methods This quality improvement project used champion-based education and electronic health record data to quantify practice patterns. Results Two hundred and seventy-four of 308 medical intensive care unit staff members (88.9%) completed education regarding spontaneous awakening and breathing trials. Compliance with spontaneous awakening trials increased significantly by 30.1% (from 42.9% to 55.8%, P .001). Compliance with spontaneous breathing trials increased nonsignificantly by 12.4% (from 66.7% to 75%, P = .10). Before and after the intervention, time intervals from trial pass to extubation (262 minutes vs 277 minutes), from trial pass to extubation order entry (193 minutes vs 266 minutes), and from extubation order entry to extubation (14 minutes vs 18.5 minutes) did not significantly change. Duration of mechanical ventilation, rates of reintubation and unplanned extubation were unchanged. Conclusion Defining compliance with spontaneous awakening and breathing trials and quantifying practice patterns are feasible and may enhance discipline-specific accountability and implementation strategies. Interprofessional education, as a sole approach, may increase compliance only modestly.
Caitlin M. Matzke (Mon,) studied this question.