PURPOSE: Unplanned extubations (UE) involve a safety risk for patients that may affect their outcome. Since the risk for UE may occur at specific times, we sought to determine at-risk time periods during which unplanned extubations are more likely to occur.
METHODS: All UE in 10 patient care units were identified from 2008 to 2009 in a retrospective chart review at a large, tertiary-care academic institution. The location, time of day, day of the week, and requirement for re-intubation was collected. The time of day was divided into four 6 hour time segments (6am-12pm; 12pm-6pm; 6pm-12am; 12am-6am). The data were also analyzed by day of the week, and divided into weekend (Saturday and Sunday) or weekday (Monday through Friday).
RESULTS: Of a total of 227 UE, 89% occurred in 5 critical care areas: surgical (SICU) 32%, medical (MICU) 20%, neurotrauma (NTICU) 20%, coronary care (CCU) 9%, and cardiovascular (CVICU) 8%. The re-intubation rates were 3% SICU, 20% MICU, 10% NTICU, 0% CCU and 12% CVICU. There were more UE during the weekend versus weekdays (58 versus 26 patients per 100 days, respectively). The majority of UE occurred during 6am-12pm (33%); followed by 12am-6am (25%), 12pm-6pm (22%), and 6pm-12am (20%). The trend of morning UE (6am-12pm) is consistent during the weekdays (34% of events) and weekends (32% of the events).
CONCLUSION: At-risk time periods for UE include weekends and the 6am to 12pm time segment during both weekdays and weekends. Factors contributing to increased risk during these periods may include sedation holidays, increased nursing and respiratory activity away from the patient room, and handoff times. Weekend factors may be related to a decreas in staffing.
CLINICAL IMPLICATIONS: Reduction of UE may be achieved by recognizing the time periods at which the patient is at highest risk.
DISCLOSURE: Amit Vaid, No Financial Disclosure Information; No Product/Research Disclosure Information