Systemwide Change of Sedation Wean Protocol Following Pediatric Laryngotracheal Reconstruction | Anesthesiology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
January 2015

Systemwide Change of Sedation Wean Protocol Following Pediatric Laryngotracheal Reconstruction

Author Affiliations
  • 1Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
  • 2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
  • 3Department of Pediatrics, Massachusetts General Hospital, Boston
JAMA Otolaryngol Head Neck Surg. 2015;141(1):27-33. doi:10.1001/jamaoto.2014.2694

Importance  Pediatric laryngotracheal reconstruction (LTR) remains the standard surgical technique for expanding a stenotic airway and necessitates a multidisciplinary team. Sedation wean following LTR is a critical component of perioperative care. We identified variation and communications deficiencies with our sedation wean practice and describe our experience implementing a standardized sedation wean protocol.

Objective  To standardize and decrease length of sedation wean in pediatric patients undergoing LTR.

Design, Setting, and Participants  Using Institute for Healthcare Improvement (IHI) methodology, we implemented systemwide change at a tertiary care center with the goal of improving care based on best practice guidelines. We created a standardized electronic sedation wean communication document and retrospectively examined our experience in 29 consecutive patients who underwent LTR before (n = 16, prewean group) and after (n = 13, postwean group) wean document implementation.

Interventions  Implementation of a standardized sedation protocol.

Main Outcomes and Measures  Presence of sedation wean document in the electronic medical record, length of sedation wean, and need for continued wean after discharge.

Results  The sedation wean document was used in 92.3% patients in the postwean group. With the new process, the mean (SD) length of sedation wean was reduced from 16.19 (11.56) days in the prewean group to 8.92 (3.37) days in the postwean group (P = .045). Fewer patients in the postwean group required continued wean after discharge (81.3% vs 33.3%; P = .02).

Conclusions and Relevance  We implemented a systemwide process change with the goal of improving care based on best practice guidelines, which significantly decreased the time required for sedation wean following LTR. Our methodological approach may have implications for other heterogeneous patient populations requiring a sedation wean.