Long-term acute care (LTAC) hospitals and units are becoming increasingly important to the management of patients who have serious, complex critical illnesses and require mechanical ventilation for extended periods of time. Kindred Healthcare, Inc., a nation-wide system of LTAC hospitals embarked on a quality initiative to establish a Ventilator Management and Weaning Best Practice. The process steps included: measurement of performance of all hospitals in the system using a riskadjusted methodology to evaluate clinical outcomes, identification of facilities with superior outcomes; structured evaluation of the characteristics, practices, and protocols of these Best Practice hospitals; and utilization of the information gleaned from these hospitals to establish evidence-based LTAC best practice ventilator management guidelines. Key characteristics of the Best Practice LTAC hospitals were: hospital-wide philosophy that “everybody weans”—that is, all disciplines actively participate and all patients are expected to wean; collaborative multidisciplinary plans of care; a consistent and a 24- hour-a-day approach to ventilator management and weaning; daily communication; mutual respect for the contributions of all disciplines to the weaning process; early, aggressive nutrition support and intervention by rehabilitation services; use of 24-hour in-hospital advance practice nurses, hospitalists, or physician assistants; and intervention by physiatrists.
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Issues in Practice| November 01 2002
Evaluating Ventilator Weaning Best Practice: A Long-term Acute Care Hospital System-wide Quality Initiative
Linda O’Bryan, RN, MS;
Kathryn Von Rueden, RN, MS, FCCM;
From Kindred Healthcare, Inc., Louisville, Ky (Ms O’Bryan); Cerner Corp., Kansas City, Mo (Ms Von Rueden and Ms Malila).
Reprint requests to Kathryn Von Rueden, RN, MS, FCCM, Practice Leader, Cerner Corp., 1953 Gallows Road, Vienna, VA 22182 (e-mail: email@example.com).
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AACN Adv Crit Care (2002) 13 (4): 567–576.
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Linda O’Bryan, Kathryn Von Rueden, Fern Malila; Evaluating Ventilator Weaning Best Practice: A Long-term Acute Care Hospital System-wide Quality Initiative. AACN Adv Crit Care 1 November 2002; 13 (4): 567–576. doi:
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