1995 OPEN FORUM Abstracts
MULTIDISCIPLINE APPROACH TO A SUCCESSFUL COST REDUCTION INITIATIVE: CHANGING FROM DISPOSABLE TO PERMANENT OXIMETRY SENSORS.
Daniel Pavlik M.Ed., RRT, Greg Nichols MSA, RRT, Jim Martin BS, RRT, Pulmonary Services Department, MetroHealth Medical Center, Cleveland, Ohio
Introduction: Conversion from disposable sensors (DS) to permanent sensors (PS) in a major academic medical center requires significant planning, multidepartment input, staff training, and ongoing user support. Continuous oximetry monitoring is a standard of care for patients receiving oxygen and/or ventilation support in our critical care units (114 beds). Other high use units are ED, PACU, and L&D. We converted to all DS in '88 to provide caregivers with readily available, easy to apply sensors. We assumed a cost savings by eliminating lost or damaged PS and improving caregiver efficiency. In the last half of '90 our critical care oximetry monitoring peaked, triggered by revised critical care guldelines and availability of monitoring units. In '92 an attempt to convert back to PS in NICU falled. Pulse oximetry monitoring hours increased 32% between '92 and '93. Cost for '93 DS reached $76,959 providing us an incentive to develop a second conversion strategy.
Methods: Key leaders, representing high use areas, were identified from nursing, purchasing, and respiratory care along with representatives from purchasing and clinical engineering. We reviewed the potential for cost savings and developed a plan incorporating previous strategles in addition to establishing central control for PS replacement, removal of DS from the storeroom, and technical support identifying non-functional sensors. Nurse managers justified, to the conversion team members, the number of PS required for their units. The inventory needed for the replacement of damaged, lost, and non-functional PS was determined by Clinical engineering staff. They also maintained control over the distribution, purchase, and tracking of all sensors against warranty dates, shipping nonfunctional sensors to the manufacturer for replacement.
YEAR MONITORING SENSORSENSOR
HOURS/YEAR EXPENSE/YEAR EXPENSE/HOUR
1992 685,464 56,1860.08
1993 707,464 76,9590.11
1994 425,216 26,0050.06
Guidelines were initlated in '94 to address the tendency of over-monitoring in non-critical care units. Conclusion: Changeover from DS to PS is challenging and can fall if taken lightly. In addition to acquiring staff buy-in and providing education, it is crucial to include all departments that engage in sensor ordering, storage, and distribution in the planning process. The partial change may have contributed to the staffs' perception the changeover was not fully supported and provided an opportunity to return to the old ways. A well defined monitoring program supports tracking compliance and data collection. The tracking process provides warranty identification eliminating unwanted sensor disposal.