1995 OPEN FORUM Abstracts
Favorable Patient Outcomes And Significant Savings For Patients Placed On Ventilator Protocols Post Open Heart Surgery - A One Year Study
Christine W. Stanish, R.R.T., Robert J. Rollins, M.D., Robert J. Wilmouth, M.D., Nadine Pratt, R.N., C. C. R.N., Karen S. Nygard, R. R. T., Steven J. Kriner, M.D. Deaconess Billings Clinic Health System, 2800 10th Ave. North, Billings, Mt. 59101
INTRODUCTION: The Critical Care ventilator management and weaning protocols were designed by a multidisaplinary team for the purpose of efficiently improving the quality of care of the ventilated patient. This was accomplished by standardization of policies and procedures related to ventilator management and development of protocols, which are detailed clinical guidelines for the safe management and weaning of the mechanically ventilated patients. The protocols are ordered by the physician and are utilized by respiratory care practitioners and nursing. Their design facilitates the fast "A" track extubation of patients meeting criteria to be extubated< = 6 hours post open heart surgery. Favorable patient outcome was defined by a minimal occurrence of specific problems with 24 hours of extubation. METHOD: 1) Monitors were placed on all ventilators and filled out by the R.C.P.'s on a Q shift basis. The monitors tracked compliance in following the protocols, specific post extubation problems occurring within 24 hours of extubation, ventilator hours, and the number of arterial blood gas draws. Compliance with the monitor itself was also monitored. 2) Data was collected via the DRG system tracking number of ABGs, ventilator hours and reintubations on open heart patients for 1 year prior to the protocols and for 1 year utilizing the protocols.
Results: 1992 preprotocol DRG study-319 open heart patients. 13.79 average ABG/patient 28.81 average vent hours/patient $1603.92 average ABG and vent charge/patient without reintubation. 4% of patients reintubated during hospital stay. 1994 Protocol DRG study 304 open heart patients 7.02 average ABG/patient 21.2 average vent hours/patient $896.85 average ABG and vent charge/patient without reintubation 44% reduction in patient charges compared to 1992 5% of patients reintubated during hospital stay 3/94 to 2/95 Protocol monitor study -321 open heart patients 6.35 average ABG/patient 21.84 average vent hours/patient $845.32 average ABG and vent charge/patient without reintubation 47% reduction in patient charges compared to 1992 DRG data Problems within 24 hours of extubation: 3% reintubation, 1% with stridor, 4% worsening CXR, 8% requiring oxygen > 6 lpm, 6% increased aerosols, suctioning, or PD&P and 1% with hemodynamic problems. Note: A patient may have more than 1 extubation problem. Savings: DRG study $707.07 saved/patient. Monitor study $758.60 saved/patient
EXPERIENCE: The protocols have been used on 218 medical patients, as well and demonstrated favorable outcomes. The protocols evolved with study findings, and during the last 4 months of the study, changes in anesthesia greatly increase the number of patients extubated< = 6 hours post op. CONCLUSION: Ventilator protocols provide a safe teamwork approach to management and weaning of patients from ventilators post open heart surgery. The DRG study shows a reduction of $214,949.28 annually without any significant increase in reintubations during the hospital stay. The monitor study showed a reduction of $243,510.60 annually with relatively minimal occurrence of post extubation problems. These reductions are in ABG and ventilator patient charges only and do not reflect savings from decreased ICU costs and decreased lengths of stay at this 272 licensed bed, community not-for-profit integrated health system. Christine Stanish, R.R.T., James Rollins, M.D., Robert Wilmouth, M.D., Nadine Pratt, R.N., C. C. R. N., Karen Nygard, R. R. T., Steven Kriner, M.D. Fax: 1-406-657-4717 Phone: 1-406-657-4075 Deaconess Billings Clinic Health System Pulmonary Center Box 37000 Billings, Mt. 59107