As part of a learning collaborative sponsored by the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth College, a multidisciplinary pediatric intensive care unit (PICU) group began meeting in 1997 to evaluate potential performance improvement (PI) opportunities. A reduction in mechanical ventilation (MV) hours was the initial team focus. The multidisciplinary team developed and implemented protocols and physician order sets outlining care for MV weaning, neuromuscular blockade/therapeutic paralyzation, and enteral feedings. Since the initiation of our protocols in July 1997, we have significantly reduced the number of hours our PICU patients receive MV.