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Invited Commentary
August 2013

Out of Bed With a Good COUGH, Just What the Doctor Ordered

Author Affiliations
  • 1Department of Surgery, Fletcher Allen Health Care, Burlington, Vermont
JAMA Surg. 2013;148(8):745-746. doi:10.1001/jamasurg.2013.375

In this study, Cassidy and his colleagues1 from Boston University Medical Center investigated the efficacy of a multidisciplinary team in reducing postoperative pulmonary complications by instituting a program called I COUGH. This program used incentive spirometry, cough and deep breathing, oral care, understanding and education, mobilization of the patient (getting out of bed ≥3 times daily), and head of bed elevation. This was an observational study looking at rates of postoperative pneumonia and unplanned intubation in patients undergoing general and vascular surgery. These outcome measures were determined using National Surgical Quality Improvement Program (NSQIP) measures. Prior to the study, their hospital was a high outlier for those pulmonary complications when compared with other similar institutions. A pulmonary care working group included surgeons, nurses, respiratory therapists, physical therapists, infectious disease personnel, and NSQIP data personnel. They compared the postoperative pulmonary complications after 1 year of institution of the multidisciplinary program and compared the results with the year prior to the planned intervention.