Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit

Kelsey Donoho; Mallory Fossa; Sarah Dabagh; Menchie Caliboso; Debra Lotstein; Srikumar Nair

doi:10.1038/s41372-021-01085-8

Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit

J Perinatol. 2021 Sep;41(9):2355-2362. doi: 10.1038/s41372-021-01085-8. Epub 2021 May 18.

Authors

Kelsey Donoho¹, Mallory Fossa^{2

3}, Sarah Dabagh^{2

4}, Menchie Caliboso^{2

5}, Debra Lotstein^{2

6}, Srikumar Nair⁷

Affiliations

¹ Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. [email protected].
² Division of Comfort and Palliative Care, Department of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
³ Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, USA.
⁴ Department of Palliative Care, Memorial Care Miller Women and Children's Hospital, Long Beach, CA, USA.
⁵ Department of Quality Information and Analytics, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
⁷ Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

Abstract

Objective: Compassionate extubation (CE) can be stressful for staff and families in the neonatal intensive care unit (NICU). Our quality improvement initiative developed and implemented a novel symptom management and family support checklist and post-debriefing template to improve team communication and staff support.

Study design: An interprofessional team performed a needs assessment, determined key drivers and intervention steps, and implemented changes using Plan-Do-Study-Act cycles. Outcomes included nursing perception of good communication with the medical team, nursing assessment of patient comfort after CE, and frequency of post-event debrief. Outcomes were analyzed using time series design with 12 months baseline data and 6 months post-implementation monitoring.

Result: Eighteen events were studied. Respondents endorsing "good" communication with the medical team increased by 60%, and debrief participation rate improved by 96%.

Conclusion: Implementation of a CE checklist and post-event debriefing sheet was associated with increased rate of debriefs and improved team communication.

MeSH terms

Airway Extubation*
Checklist
Communication
Humans
Infant, Newborn
Intensive Care Units, Neonatal*
Patient Care Team