The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

A MULTIDISCIPLINARY APPROACH TO COST REDUCTION IN THE MANAGEMENT OF INFANTS AND CHILDREN UNDERGOING SURGERY FOR CONGENITAL HEART DISEASE

Mary K. Dekeon R.R.T., Thomas J. Kulik M.D., Kenneth P. Bandy R.R.T.,Michigan Congenital Heart Center, University of Michigan Medical Center, Ann Arbor, Michigan

Objective: The development of a multidisciplinary task force to identify areas of improved efficiency. This unique group consisted of operating room and intensive care personnel who attended regular meetings to discuss changes that could be implemented to improve cost effectiveness and at the same time, enhance the transition from the operating room to the intensive care unit.

Methods: We began bi-monthly meetings with the director of the intensive care unit, a thoracic surgeon, staff nurses, the director of pediatric anesthesia and the respiratory care clinical specialist from the intensive care unit. The following goals were targeted: 1. Reduce the duplicate use of disposable respiratory equipment, medication and blood products. 2. Identify procedures and tests that were redundant or unnecessary. Prior to our meetings ventilator circuits, pressure transducers and oxygen saturation probes were set up in both areas. This practice was changed so that these items were only set up in the operating room and then transferred to the intensive care unit with the patient, eliminating waste. Problems with transfers were carefully tracked and addressed through subsequent meetings.

Estimated Savings of Disposable Equipment

Item Cost

Ventilator circuit 8.33

Humidifier 7.34

Oxygen saturation probes 15.55

Pressure transducers -

$3.54 ea. x 2-3 8.85

Total per patient $40.07

Annual savings (based on

approx. 500 patients/year) $20,035.00

Duplication of laboratory tests were also examined. Our practice was to run electrolytes with blood gases at our point of care lab in the ICU to obtain ionized calcium, whole blood sodium and potassium values. Additional blood was drawn for serum K+ every six hours and sent to our central lab. We conducted an in hospital comparison of whole blood potassium levels with serum potassium levels. This comparison demonstrated no clinically significant difference, therefore, routine sampling for serum potassium was discontinued, reducing the total amount of blood drawn, and reducing the amount of personnel time. A similar evaluation was made comparing hematocrit values obtained by conductivity on the blood gas analyzer with those obtained by spun hematocrit. Similar results were demonstrated, eliminating the need for spun hematocrits. Conclusion: The development of a multidisciplinary task force was initiated to identify cost saving issues became a process which unified disciplines to achieve consistency, cost effectiveness and cooperation for a total team approach to quality operative and post-operative management of intants and children with congenital heart disease.

Reference: OF-96-139

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