Title |
Implementation of a new strategy to improve the peri‐operative management of neuromuscular blockade and its effects on postoperative pulmonary complications
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Published in |
Anaesthesia, July 2018
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DOI | 10.1111/anae.14326 |
Pubmed ID | |
Authors |
M. I. Rudolph, H. V. Chitilian, P. Y. Ng, F. P. Timm, A. V. Agarwala, A. B. Doney, S. K. Ramachandran, T. T. Houle, M. Eikermann |
Abstract |
Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra-operative documentation of train-of-four measurement before administration of neostigmine. We conducted a pre-specified analysis of data obtained in our quality improvement study. Additional analyses were conducted in a propensity-matched cohort. An interrupted time series design was used to discriminate between the intervention and a counterfactual scenario. We analysed 12,025 consecutive surgical cases performed in 2015. Postoperative pulmonary complications occurred in 220 (7.5%) of 2937 cases pre-intervention and 568 (6.3%) of 9088 cases post-intervention. Adjusted regression analyses showed significantly a lower risk of postoperative pulmonary complications (OR 0.73 (95%CI 0.61-0.88); p = 0.001), lower costs (incidence rate ratio 0.95 (95%CI 0.93-0.97); p < 0.001) and shorter duration of hospital stay (incidence rate ratio 0.91 (95%CI 0.87-0.94); p < 0.001) after implementation of the quality improvement initiative. Analyses in a propensity-matched sample (n = 2936 per group) and interrupted time series analysis (n = 27,202 cases) confirmed the findings. Our data show that a local, multifaceted quality improvement initiative can enhance the quality of intra-operative neuromuscular blocking agent utilisation, thereby reducing the incidence of postoperative pulmonary complications. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 5 | 13% |
Colombia | 4 | 11% |
Spain | 2 | 5% |
Nepal | 2 | 5% |
United States | 2 | 5% |
Morocco | 1 | 3% |
Netherlands | 1 | 3% |
Argentina | 1 | 3% |
Mexico | 1 | 3% |
Other | 5 | 13% |
Unknown | 14 | 37% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 29 | 76% |
Practitioners (doctors, other healthcare professionals) | 6 | 16% |
Science communicators (journalists, bloggers, editors) | 2 | 5% |
Scientists | 1 | 3% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 42 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 6 | 14% |
Student > Ph. D. Student | 5 | 12% |
Student > Bachelor | 3 | 7% |
Lecturer | 3 | 7% |
Professor | 3 | 7% |
Other | 8 | 19% |
Unknown | 14 | 33% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 14 | 33% |
Nursing and Health Professions | 3 | 7% |
Psychology | 2 | 5% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 2% |
Veterinary Science and Veterinary Medicine | 1 | 2% |
Other | 3 | 7% |
Unknown | 18 | 43% |