Chest tube removal algorithm is associated with decreased chest tube duration in pediatric cardiac surgical patients. J Thorac Cardiovasc Surg 2019 Oct;158(4):1209-1217
Date
05/31/2019Pubmed ID
31147165DOI
10.1016/j.jtcvs.2019.03.120Scopus ID
2-s2.0-85066102029 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
OBJECTIVE: Management of chest tubes in adult and pediatric patients is highly variable. There are no published guidelines for pediatric cardiac surgical patients. Our center undertook a quality improvement project aimed at reducing chest tube duration and length of stay in postsurgical pediatric cardiac patients.
METHODS: A work group identified 2 opportunities for reducing chest tube duration: standardizing removal criteria and increasing frequency of assessment for removal. An algorithm was created, and chest tube assessments were increased to twice daily. All postsurgical cardiac patients were managed according to the algorithm. Outcome measure reporting was limited to patients age 1 month to 18 years with a biventricular surgical procedure. Outcome measures included chest tube duration, cardiac intensive care unit and hospital length of stay, and cost of hospitalization. Process measure was documentation of chest tube assessments. The balancing measure was chest tube reinsertions.
RESULTS: Between April 2016 and July 2018, 126 patients aged 1 month to 18 years underwent a biventricular surgical procedure. Mean chest tube duration decreased from 61 to 47 hours. Cardiac intensive care unit length of stay decreased from 141 hours to 89 hours, hospital length of stay decreased from 266 to 156 hours, and average hospitalization cost decreased from $75,881 to $48,118. There was no increase in chest tube reinsertions.
CONCLUSIONS: Implementation of a chest tube removal algorithm for pediatric cardiac surgery patients resulted in decreased chest tube duration and was associated with decreased length of stay and costs without an increase in reinsertions. More significant impact may be attainable with more aggressive approach to removal.
Author List
Bertrandt RA, Saudek DM, Scott JP, Madrzak M, Miranda MB, Ghanayem NS, Woods RKAuthors
Rebecca Ann Bertrandt MD Associate Professor in the Pediatrics department at Medical College of WisconsinDavid Saudek MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD Professor in the Anesthesiology department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAlgorithms
Cardiac Surgical Procedures
Chest Tubes
Child
Child, Preschool
Cost Savings
Cost-Benefit Analysis
Decision Support Techniques
Device Removal
Drainage
Female
Hospital Costs
Humans
Infant
Length of Stay
Male
Quality Improvement
Quality Indicators, Health Care
Time Factors
Treatment Outcome
