Pediatric Resident Stony Brook Children's Hospital Stony Brook, New York, United States
Background: Iatrogenic drug withdrawal (IDW) after mechanical ventilation in the pediatric intensive care unit (PICU) is treated with a variety of medications. In our institution, there is significant practice variation in how these medications are weaned after discontinuation of continuous infusions. This results in disparities in the duration of medication wean and hospitalization time that have negative impacts on the patient and the healthcare institution. Objective: The primary goal of this project is to reduce the length of hospitalization for patients requiring a medication wean for IDW at Stony Brook Children’s by 30% by February 2026. Secondary goals include minimizing withdrawal, decreasing length of wean, improving accuracy of withdrawal scoring and improving education for families and primary care providers. Design/Methods: Retrospective baseline data was collected between 1/2023 and 1/2024 to identify medication wean duration, withdrawal scores and discharge trends for all patients being treated for IDW. Multiple plan-do-study-act (PDSA) cycles were initiated which included: modification of the medication wean protocol, guidance for speeding up medication wean, and early inclusion of social work for discharge planning. Future PDSA cycles include improving withdrawal scoring accuracy and creation of educational materials for families and primary care providers to help guide outpatient monitoring. Results: Baseline data included 21 patients with ongoing hospitalization for medication weaning. Of the 21 patients, 33.3% remained hospitalized for medication weaning with no other discharge barriers, 33.3% were discharged home while continuing their wean and 33.3% remained admitted for reasons aside from medication weaning. The average hospital length of stay after PICU downgrade was 9 days. Application of the new algorithm retrospectively for the patients who remained admitted for sedation wean, could reduce length of stay by 3 to 6 days. Preliminary prospective data on four patients to date, utilizing the new algorithm shows an average hospital length of stay after PICU downgrade of 5.3 days, a reduction of 41.1%.
Conclusion(s): In patients with IDW, application of a multi-modal standardized protocol for medication weaning can reduce hospital length of stay. Further analysis is needed to determine the impact on overall medication exposure.
