Optimizing neuromuscular block monitoring and reversal: A large-scale quality improvement initiative in a diverse healthcare setting
Authors' conclusion
This initiative demonstrates successful large-scale integration of quantitative TOF monitoring and evidence based NMB management across a diverse medical center, while highlighting important barriers in implementation.
Study context
- Population
- Surgical cases using neuromuscular block (NMB) agents at a large multi-campus urban medical center
- Participants
- 35,198 surgical cases
- Comparison
- Before vs after QI interventions to increase Train-of-Four (TOF) monitoring and evidence-based, cost-effective NMB reversal
- Outcome
- TOF monitoring
Methodological detailsinterdisciplinary, multi-campus, Plan-Do-Study-Act cycles, qualitative interviews
- Interdisciplinary
- Multi-campus
- Plan-Do-Study-Act cycles
- Qualitative interviews
Main finding
As reported in the abstract
Sustained increase in TOF monitoring
42 % to 83 %
Further findings
Postoperative respiratory complications
| RR (95 % CI) | ||
|---|---|---|
| Over the course of the initiativeDecreased by 41 % | 0.59 (0.32–0.96) | |
| 0.20.5125Relative risk (log scale) |
TOF ratio documentation and sugammadex use
- Significant increases in TOF ratio documentation and sugammadex use
Drivers of TOF monitoring
- Largest increases associated with financial incentives for department-wide target monitoring rate
Original publication
Optimizing neuromuscular block monitoring and reversal: A large-scale quality improvement initiative in a diverse healthcare setting. J Clin Anesth. Published 12 December 2024. doi:10.
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