Establishing the content validity of an early extubation protocol: A quality improvement project for improving early extubation of CABG patients

Abstract

Introduction

Patients undergoing coronary bypass graft will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes, but organizational outcomes as well. These patients that are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the post-operative cardiac surgical adult patient. Method

For the purpose of establishing content validity of an early extubation protocol, two protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol, based on a five-question survey. Their response was used to calculate a scale-content validity index (S-CYI) and an item-content validity index (I-CYI).

Results

Twelve of fifteen experts participated in the project. The content validity was estimated using I) inter-rater agreement for relevance for each item (I-CYI) and 2) scale content validity (S-CYI). The means were established for each item. Content validity was estimated using I) inter-rater agreement for relevance for each item (I-CYI: 0.75 to 1.00); and the scale content validity index (S-CYI/average = 0.92). Cronbach's alpha was estimated to establish reliability (0.972). Conclusion

Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in post-operative cardiac surgery patients.