Browsing by Author "Hole, Acrista J."

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    Implementation of a High Flow Nasal Cannula Management Protocol in the Pediatric ICU
    (American Association for Respiratory Care, 2021-04-01) Peterson, Rachel J.; Hassumani, Daniel O.; Hole, Acrista J.; Slaven, James E.; Tori, Alvaro J.; Abu-Sultaneh, Samer
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    An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment
    (Wolters Kluwer, 2017-10) Abu-Sultaneh, Samer; Hole, Acrista J.; Tori, Alvaro J.; Benneyworth, Brian D.; Lutfi, Riad; Mastropietro, Christopher W.; Pediatrics, School of Medicine
    Objectives: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist–led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. Design: A quality improvement project. Setting: Single center, tertiary care Children’s Hospital PICU. Patients: All intubated patients admitted to PICU requiring conventional mechanical ventilation between February 2013 and January 2016. Interventions: A working group of pediatric intensivists, respiratory therapists, nurses, and information technology specialists established the protocol, standardized documentation via the electronic medical record, and planned education. Daily spontaneous breathing trial protocol implementation began in February 2015. All patients on mechanical ventilation were screened daily at approximately 4 AM by a respiratory therapist to determine daily spontaneous breathing trial eligibility. If all screening criteria were met, patients were placed on continuous positive airway pressure of 5 cm H2O with pressure support of 8 cm H2O for up to 2 hours. If tolerated, patients would be extubated to supplemental oxygen delivered via nasal cannula in the morning, after intensivist approval. Daily audits were done to assess screening compliance and accuracy of documentation. Measurements and Main Results: We analyzed data from 398 mechanically ventilated patients during daily spontaneous breathing trial period (February 2015–January 2016), compared with 833 patients from the pre–daily spontaneous breathing trial period (February 2013–January 2015). During the daily spontaneous breathing trial period, daily screening occurred in 92% of patients. Extubation failure decreased from 7.8% in the pre–daily spontaneous breathing trial period to 4.5% in daily spontaneous breathing trial period. The use of high-flow nasal cannula slightly increased during the project, while there was no change in duration of mechanical ventilation or the use of noninvasive ventilation. Conclusions: An interprofessionally developed respiratory therapist–led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events.
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    Reducing Unnecessary Nitric Oxide Use: A Hospital-Wide, Respiratory Therapist-Driven Quality Improvement Project
    (Daedalus Enterprises, 2021-01) Rogerson, Colin M.; Tori, Alvaro J.; Hole, Acrista J.; Summitt, Elizabeth; Allen, Jayme D.; Abu-Sultaneh, Samer; Valentine, Kevin M.; Pediatrics, School of Medicine
    BACKGROUND: We sought to evaluate the institutional use of inhaled nitric oxide (INO) and to create a pathway to reduce waste using the Institute for Healthcare Improvement's model for improvement. Our aim was to reduce the use of INO by 20% within 8 months. METHODS: This was a prospective, respiratory therapist-driven, quality improvement project. We implemented a hospital-wide INO utilization protocol that was developed by neonatology, pediatric critical care, cardiac critical care, and respiratory therapy. INO use and respiratory therapist input for protocol failures were derived from the electronic medical record and were used to generate improvement opportunities. Monthly total hospital use of INO (in hours) was used as the primary outcome measure. Median hourly use per subject (evaluated in groups of 7 subjects) was used as a secondary outcome measure. New sildenafil dosing was tabulated for pre- and post-INO weaning protocol intervention as a balancing measure. Subjects included all patients in the hospital who were given INO therapy during the specified timeframe. RESULTS: Hospital-wide total hours were reduced from 1,515 h/month to 930 h/month. This hospital-wide reduction of 39% equates to a cost-avoidance of approximately $912,000 per year based on 2018 costs of INO of $130 per hour. Median hours of INO per subject decreased from 88 h to 50 h. Sildenafil was started in 18 of 98 subjects (18%) in the pre-intervention period and in 12 of 109 subjects (11%) in the post-intervention period (P = .27). CONCLUSIONS: A hospital-wide, multi-professional initiative led to a reduction in unnecessary INO use, resulting in decreased subject exposure and associated cost avoidance.