Lung Protective Ventilation
a QI story
William Hightower, MD
Henry Ford West Bloomfield Hospital
I have no disclosures
Let’s cut to the chase
• Everyone in this room [now] understands the benefits of a lung
protective ventilation strategy, right?
• Lots of anesthesia providers trained long before this strategy evolved
• How do we bridge the gap between what we should be doing and
what we are doing?
Solutions (that probably didn’t work all that well)
• Education meetings
• Ideal body weight charts
• Calculators and apps
• Nagging, harassing, etc.
• It is hard to break established habits!
Designing a better cognitive aid
• Henry Ford Health System goes live with Epic in 2013 and 2014
• In the following years, Epic adds
some fun new functionality
• I start to think about using these tools
• I place a ticket with HFHS IT and wait…and wait…and wait…
• In 2016, HFHS gears up to join ASPIRE Cohort 3…and my ticket goes to
the front of the line!
Lung protection strategy event
• A new event which is the Quick Event Sequence for all GA macros
Lung protection strategy event
• This event fires a report (popup window) which calculates the
suggested tidal volume based on patient IBW (6-8mL/kg)
• The report also suggests PEEP and recruitment maneuvers
• The event also triggers an hourly recruitment maneuver reminder
The build
PULM 01 (<10mL/kg IBW) PULM 02 (<8mL/kg IBW)
Measure performance (HFWBH)
Lung protection event went live April 2017
What we learned
• Staff was very receptive to using the event (automatic and easy)
• Staff liked the idea of a tidal volume range
• Use QI (ASPIRE) to get stuff done
• Cheers to our Epic build team (Josh Barron) and TS (Evan Flink)
• MOCA 2.0 Part IV 25 credits for yours truly
