1996 OPEN FORUM Abstracts
THE ECONOMIC IMPACT OF UNNECESSARY OXYGEN FLOW IN THE NICU AND A SOLUTION.
Thomas J. Kallstrom R.R.T. and Robert L. Chatburn R.R.T. Rainbow Babies and Childrens Hospital, Cleveland, OH.
Introduction: It has been a long-standing convention in our NICU that self inflating resuscitation bags are readily accessible for the purposes of hand ventilating infants. To accommodate this, all of our flowmeters attached to resuscitation bags continually run at 10 LPM of oxygen. Anything less than 100% oxygen is delivered with a blender. In keeping with our departments practice of frugality, we sought to determine the economic impact of this policy Methods: We assigned our RCPs to go to the bedside twice a day for 14 consecutive days. They were instructed to take inventory of all bed spaces and to note if a bag was turned on and at what flow and FIO2. We did not take blender bleed factor into consideration. If any delivered gas was less than 100% oxygen, we calculated the actual flow of oxygen in the delivered gas. After 14 days we totaled the amount of oxygen that was actually used. An average daily census of the unit was determined. From this data we extrapolated what the wasted oxygen would be given the census from the previous year (1994). The amount of oxygen that was wasted was calculated at our cost of $.253/cubic foot. Because oxygen is delivered in LPM we converted LPM to cubic foot using a conversion factor of 0.035316. Results: The average daily amount of oxygen that was displaced into the nursery but not clinically used was 10,656 liters per patient per day. Based on our 1994 patient census in this unit we found that 115,905,312 liters of oxygen was wasted. This generated an annual cost of $10,351.00. Conclusion: We found we had significantly misspent our resources on oxygen not utilized for patient care. This data was presented to our NICU Interdisciplinary Council along with a proposal that we use an a flow limiting device (Instrumentation Industries). The device is used to hang a resuscitation bag and flow is only generated once the bag is lifted from the bar, presumably for the purpose of manual ventilation. The cost of these were $100.00/unit. We purchased these units for each bed and we expect to recoup the cost of the initial investment in less than 5 months.