Impact of Plan-Do-Study-Act Cycle-Based Quality Improvement on Head-of-Bed Elevation Compliance, Cuff Pressure Management and Ventilator-Associated Pneumonia in Intensive Care Units: A Before-After Study.

OBJECTIVE

This study aimed to evaluate the association between Plan-Do-Study-Act (PDSA) cycle-based quality improvement measures and the correct implementation rate of head-of-bed elevation, artificial airway cuff pressure compliance, and ventilator-associated pneumonia (VAP) incidence in mechanically ventilated patients, and to identify independent influencing factors of the two core care indicators.

METHODS

A total of 4305 patients receiving mechanical ventilation for ≥48 hours in the Emergency Intensive Care Unit (EICU) and Respiratory Intensive Care Unit (RICU) were enrolled, divided into the pre-implementation group (n=2163, Jan-Dec 2024) and the post-implementation group (n=2142, Jan-Dec 2025). The post-implementation group received comprehensive improvement measures based on the PDSA cycle, including standardized monitoring, normalized measuring tools and continuous quality control. The two indicators' compliance rates and VAP incidence were compared between groups. Univariate and multivariate Logistic regression analyses were used to identify influencing factors, and Spearman correlation analysis was performed to explore the relationship between indicator compliance and VAP incidence.

RESULTS

The post-implementation group had significantly higher compliance rates of both indicators and lower VAP incidence (all P<0.05). Both indicators were significantly negatively correlated with VAP incidence (all P<0.001). APACHE II score ≥25, mechanical ventilation ≥10 days, patient agitation and delirium, and insufficient nursing staffing were independent risk factors for lower compliance rates, while standardized processes and quality monitoring were independent protective factors (all P<0.05).

CONCLUSION

PDSA cycle-based comprehensive quality improvement measures were associated with improved compliance rates of head-of-bed elevation and artificial airway cuff pressure in mechanically ventilated patients, and lower VAP incidence. Standardized procedures and continuous quality monitoring are key to maintaining high compliance of these two core VAP prevention indicators.