1995 OPEN FORUM Abstracts
USE OF A THERAPIST-DRIVEN BRONCHIAL HYGIENE PROTOCOL IN PATIENTS UNDERGOING CARDIAC SURGERY
Laura N. Kanov, BS,RRT, Respiratory Care Director, Robert Zeck, MD, Medical Director for Respiratory Care,Hinsdale Hospital, 120 N. Oak St.,Hinsdale, IL 60521
BACKGROUND: Forces determining the future of health care mandate lower costs while maintaining quality outcomes. This study examines the effects of a therapist-driven bronchial hygiene program on the charges, lengths of stay, ICU days and complications in patients undergoing cardiac surgery.
Methods: Evaluations were done preoperatively (excluding patients proceeding directly to surgery from the cath lab)to determine pre-op diagnostic needs. Patient education was done at this time and an incentive spirometry goal was established as well. Patients were seen post-op as soon as hemodynamically stable to determine bronchial hygiene needs and followed up each subsequent shift. Needs were determined using a flow diagram which assessed indicators such as atelectasis, vital capacity and secretion production. All parts of the evaluation and educational process were perfomed by specially trained therapists, while respiratory modalities could be performed by any staff member. STUDYDESIGN: We evaluated all patients undergoing surgery for CABG or Valve Repair/Replacement over a three month period (80 in total). We compared charges, length of stay, ICU days and complications to (all) 65 patients in the 3 month period immediately preceding the pilot study and (all) 99 patients in the same 3 month period of the previous year. Data were evaluated retrospectively to determine the mathematical means and were compared. An ANOVA was used for further analysis.
Results: Patients in the pilot group had lower mean hospital charges, respiratory charges, length of stay, and ICU days. While comorbidities were slightly more prevalent in the pilot group, no significant difference existed in complications among the groups. Patients with chronic lung disease showed the most improvement over the control groups including decreased incidence of pneumonia - 15.4% in the pilot group compared to 54.5% in control 1 and 37.5% in control 2. CONCLUSION: Although ANOVA indicated no statistically significant differences among the groups, our results suggest that a bronchial hygiene program driven by specially-trained therapists, which includes patient education, is associated with reduced respiratory and hospital charges, decreased lengths of stay and ICU days in patients having major cardiac surgeries, particularly in patients with chronic lung disease.
Mean Values - All Patients
GroupnHosp. $ Resp $ ABG$ LOS ICU Days
Pilot80 $72,569 $3,592 $4,611 11.4 5.0
Control 1 65 $88,424 $4,783 $6,142 13.4 6.6
Control 2 99 $88,223 $5,842 $3,510 13.9 6.2
ANOVA p=0.26p=0.26 p=0.00 p=0.36 p=0.46
Mean Values - Patients with Chronic Lung Disease
Group nHosp $ Resp $ABG $ LOS ICU Days
Pilot13 $70,637$4,847$4,38411.8 4.9
Control 1 11 $169,336 $13,963 $11,029 28.1 15.9
Control 2 8$187,942 $18,977 $4,91226.0 18.6
ANOVA p=0.09 p=0.23p=0.01p=0.09p=0.09