Quality Improvement Intervention Targeting Ventilator Management Ground & Air Medical qUality in Transport (GAMUT) Metric Improves Documentation and Patient Care Practices.

Abstract

Objectives: The object of this study was to evaluate the effect of a bundled quality improvement (QI) intervention targeting implementation of the Ground & Air Medical qUality in Transport (GAMUT) metric plateau pressure (Pplat) < 30 mmHg on the incidence of Pplat documentation and rate of lung protective ventilation (LPV).

Methods: A QI-bundle encompassing education, spaced repetition, and signposting was implemented in a university affiliated, physician/nurse-staffed critical care transport (CCT) program. Our primary aim was to improve the rate of LPV during CCT with the secondary aim of improving the documentation rate of Pplat. Statistical analysis was performed pre- and post-QI intervention using a Pearson chi-square, 95% confidence intervals (CI), nonparametric tests of medians, and two-sample t-test as appropriate. Cohen's effect size was calculated to evaluate the magnitude of difference. Control charts assess changes over time.

Results: Before QI bundle implementation, Pplat was documented in 11.8% of charts compared to 96.2% post-implementation (p ≤ 0.001, difference 84.4%, 95% CI [49.1%, 66.2%]). There was a statistically significant increase in the proportion of patients ventilated with both Pplat < 30 mmHg and driving pressure (DP) < 15 mmHg post-QI bundle implementation (p ≤ 0.001, difference 20.9%, 95% CI 3.20%, 38.6% and p ≤ 0.001, difference 45.3%, 95% CI 14.8%, 57.8%, respectively).

Conclusions: To our knowledge, this is the first report of a QI initiative targeting implementation of a GAMUT metric to improve both documentation and patient care practices. Our findings indicate that our QI intervention improved documentation of Pplat by nearly nine-fold. We also demonstrated sustained improvement in patient care with higher rates of LPV as defined by Pplat < 30 mmHg and DP < 15 mmHg post-implementation.