The Ⅰ COUGH Multidisciplinary Perioperative Pulmonary Care Program: One Decade of Experience

摘要

Background: Surgical quality improvement programs can provide meaningful benefits for patient outcomes, but sustainabilityof initial success is rarely described. In response to data that revealed a greater than predicted likelihood of postoperativepulmonary complications in one hospital, the study team designed a standardized program to improve care. This study offersa long-term perspective of the effort, including special challenges and lessons learned about sustaining success.Methods: A before-after study was conducted at an academic safety-net hospital. A multidisciplinary team developedtactics to reduce pulmonary complications, designated by the acronym I COUGH : I ncentive spirometry, C oughing/deepbreathing, O ral care, U nderstanding (education), G etting out of bed, and H ead of bed elevation. Clinical practices wereaudited and compared to actual and risk-adjusted pulmonary outcomes.Results: Improvements in compliance with the I COUGH elements were initially promising, but baseline behaviors even-tually returned. Adverse outcomes have inversely correlated with process adherence in “sawtooth”patterns. Rejuvenationefforts have successively extended beyond the literal principles of the acronym to foster broader institutional commitment toperioperative pulmonary care, restoring favorable trends in both process and outcomes. A more comprehensive I COUGHprogram now extends beyond the acronym, applying numerous concepts to support the original program.Conclusion: I COUGH, a standardized perioperative pulmonary care program, initially improved performance and re-duced pulmonary complications. However, loss of early program momentum corresponded with a return to baseline outcomes.Fortunately, an overall favorable trend has resulted from a coordinated rededication to I COUGH that requiressteadfast commitment and creative responses to numerous cultural barriers.