Abstract

Background/Purpose: The Society of Thoracic Surgeons (STS) has stated that postoperative time to extubation (TTE) within six hours of surgery closure for select cardiothoracic surgery (CT) patients is safe. In response, we conducted a retrospective chart review to assess CT surgery extubation times and implemented strategies to ensure we meet the STS guideline.

Methodology: Beginning in 2020, a multidisciplinary team of stakeholders, including nursing leadership, clinical specialists, respiratory therapists, advanced practice providers, intensivists, and surgeons, met weekly to develop an action plan for adherence to the six-hour TTE goal. Changes included modifying anesthesia settings to facilitate quicker weaning from ventilator support, implementing whiteboards and case clocks for real-time monitoring, and incorporating shift summaries detailing anticipated extubation times. Enhanced communication among nursing, respiratory therapists, and clinicians ensured timely interventions as patients approached the six-hour TTE mark.

Results: In 2017, the median TTE was seven hours and 27 minutes. Following implementation efforts, in 2020 the median TTE fell below six hours. In 2024, the median TTE was further reduced to five hours and 11 minutes, reflecting a 72% median time reduction from 2017.

Implications: This TTE reduction highlights the success of multidisciplinary collaboration and targeted practice changes. TTE within six hours post-surgery may contribute to shorter ICU stays, reduced healthcare costs, and improved patient outcomes without increasing morbidity or mortality. Further research is suggested to explore refinements for specific CT patient subgroups to enhance safety and efficiency.