I COUGH Reducing Postoperative Pulmonary Complications With a Multidisciplinary Patient Care Program Reducing Postoperative Pulmonary Complications

Cassidy MR, Rosenkranz P, McCabe K, et al. — Wed, 05 Jun 2013 00:00:00 GMT

Importance

Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed.

Objectives

To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications.

Design

A before-after trial comparing our National Surgical Quality Improvement Program (NSQIP) pulmonary outcomes before and after implementing I COUGH, a multidisciplinary pulmonary care program.

Setting

An urban, academic, safety-net hospital.

Participants

All patients who underwent general or vascular surgery at our institution during a 1-year period before and after implementation of I COUGH.

Interventions

A multidisciplinary team developed a strategy to reduce pulmonary complications based on comprehensive patient and family education and a set of standardized electronic physician orders to specify early postoperative mobilization and pulmonary care. Designated by the acronym I COUGH, the program emphasizes i ncentive spirometry, c oughing and deep breathing, o ral care (brushing teeth and using mouthwash twice daily), u nderstanding (patient and family education), g etting out of bed at least 3 times daily, and h ead-of-bed elevation. Nursing and physician education promoted a culture of mobilization and I COUGH interventions. I COUGH was implemented for all general surgery and vascular surgery patients at our institution in August 2010.

Main Outcomes and Measures

The NSQIP-reported incidence and risk-adjusted ratios of postoperative pneumonia and unplanned intubation, which NSQIP reports as observed-expected (OE) ratios for the 1-year period before implementing I COUGH and as odds ratios (ORs, statistically comparable to OE ratios) for the period after its implementation.

Results

Before implementation of I COUGH, our incidence of postoperative pneumonia was 2.6%, falling to 1.6% after its implementation, and risk-adjusted outcomes fell from an OE ratio of 2.13 to an OR of 1.58. The incidence of unplanned intubations was 2.0% before I COUGH and 1.2% after I COUGH, with risk-adjusted outcomes decreasing from an OE ratio of 2.10 to an OR of 1.31.

Conclusions and Relevance

I COUGH, a standardized postoperative care program emphasizing patient education, early mobilization, and pulmonary interventions, reduced the incidence of postoperative pneumonia and unplanned intubation among our patients.

JAMA Surgery: Medication Error Topic Collection

I COUGH Reducing Postoperative Pulmonary Complications With a Multidisciplinary Patient Care Program Reducing Postoperative Pulmonary Complications