1996 OPEN FORUM Abstracts
USE OF RESPIRATORY INDUCTIVE PLETHYSMOGRAPHY IN AN INTERMEDIATE CARE UNIT: COST SAVINGS TOGETHER WITH QUALITY CARE.
Mary Beth Parr, MSN, RN, CCRN, Julie Mallett, MA, RCP, RRT, Brad Coffman, Congetta Gregg, Dan Rosenbaum, John Saunders, Michael E. Kalafer, MD. Sharp Memorial Hospital, San Diego, CA.
Transfer of long term, chronic, critical care patients to an intermediate care unit (IMCU) has been demonstrated to provide a cost savings (Krieger 1990, Elpern 1991). This abstract will review the experiences with use of respiratory inductive plethysmography (RIP) in a 400 bed community hospital. RIP can be used to monitor changes in breathing rate, tidal volume and labored breathing index. The current RIP system includes a central station with the capacity to monitor 8 patients in the IMCU. The system has been in place for over two years. Original costs of $140,000 included purchase and installation of the equipment and staff education.
Method: Daily collection sheets were completed by the respiratory therapist and included such items as reasons for monitoring, number of blood gases, number of cardiac and respiratory arrests. This information provided demographic data along with potential cost savings and quality data points.
Findings: We have monitored 181 patients for a total of 381 patient days from December 1993 until January 1996, with an average length of monitoring of 2.1 days with a range from 1 day to 20 days. Reasons for monitoring included impending respiratory failure (29.9%), sleep monitoring (17%), ventilator wearing (14.7%), neuromuscular (12.5%), trauma (7.3%), noninvasive ventilation (4.2%) and miscellaneous (14.4%). The total number of arterial blood gases (ABG's) was 21 for the 2 year period. During the evaluation period there was one cardiac arrest and one emergent intubation for the monitored patients. Cost savings were calculated by comparing the average daily cost of the ICU verses the cost of the IMCU. Average daily cost is defined as cost of direct patient care and includes nursing care, respiratory therapy and pharmacy. Fiscal year 1994 and 1995 data were used to determine average daily cost for the cost savings equation. An estimated 50% of the patients in the IMCU would have been housed in the ICU if the RIP system was not in place. This was based on a 1992 pre-purchase survey of patients in the ICU who potentially could have been housed in IMCU. The total cost savings is conservative as the current IMCU population has a higher acuity that those reviewed in 1992. The total costs savings for the two year period, based on the transfer from the ICU to the IMCU, was $74,965.
Conclusion: The RIP system has enabled us to provide appropriate level of care in the IMCU for populations who otherwise consume resources in the ICU. The cost savings data are significant but also important is the quality of care provided. With one arrest and one emergent intubation, we concluded that earlier interventions were took place due to the information provided from the RIP. Also, the decrease in ABG's can be contributed to better respiratory monitoring. The RIP system housed in an IMCU has significant cost savings potential. At full capacity, with 8 patients per day, the potential for cost savings is $1,540,300. In addition to cost savings, we have cared for patients at a lower level of care while continuing to monitor the respiratory system. The task at hand now is to continue education and marketing of medical and health care staff to increase utilization.