1997 OPEN FORUM Abstracts
A PEDIATRIC ASTHMA UNIT STAFFED BY RESPIRATORY THERAPIST DECREASES LENGTH OF STAY, COST AND CHARGES.
Timothy R. Myers RRT, Robert L. Chatburn RRT, Carolyn Keresmar MD. Rainbow Babies & Children's Hospital and Case Western Reserve University. Cleveland, OH.
The purpose of this study was to determine the effects of an Asthma Care Unit (ACU) staffed by respiratory therapists on length of stay (LOS), hospital cost, charges to payers, care path variances and post-discharge outcomes for children admitted to our hospital for asthma. METHOD: During the period from 9/1/96 to 1/31/97 patients were admitted to a newly-developed ACU staffed by respiratory therapists. An historical control group was comprised of data from 10/1/95 through 8/31/96 from multiple patient divisions staffed by registered nurses. All patients had their asthma treatment managed by the same Asthma Care Path protocol. Patients admitted to the pediatric intensive care unit were excluded from both study groups. Care path variances (deviations from care path protocol) were tracked on a patient-by-patient basis. ACP protocol administers telephone follow-up surveys to track post-discharge comorbidity outcomes. Mean values for demographics, inpatient outcomes and post-discharge outcomes were compared with t-tests. Percentages by race were compared using a Fisher exact test. Distributions by severity class were compared with the Chi Square test. Results: Demographic and outcome variables are shown in the table below as mean values. Comparing the ACU and historical control groups, there were no differences in demographic variables or in the distributions by severity class.
Asthma Unit Historical Control p-values
Number 262 267
Age (years) 6.3 (4.5) 6.8 (4.8) 0.1912
Non-Caucasian 75.7% 76.5% 0.8386
Severity Class 0.7919
Severe 126 132
Moderate 30 32
Mild 82 74
Unknown 24 29
Length of stay (days) 1.78 (0.75) 2.04 (0.85) 0.0003
Variances 2.70 (2.45) 9.40 (5.34) < 0.0001
Hospital cost/case $1,375 ($600) $1,522 ($750) 0.0234
Patient charge/case $2,447 ($1,079) $2,732 ($1,319) 0.0246
Quality of Life Outcomes
Symptomatic Days 4.86 (7.7) 5.61 (7.2) 0.3463
School Days Missed 5.31 (3.60) 3.80 (4.46) 0.0256
Work Days Missed 3.98 (3.10) 3.31 (3.62) 0.3578
CONCLUSION: An ACU staffed by therapists significantly reduced LOS and care path variances, while resulting in a more cost-effective use of resources. There was no significant increase in symptomatic days. Average cost (i.e., hospital fixed plus variable) savings /case was $150. Estimated hospital cost savings /year (based on census of 900 patients) is $135,000 (an additional $150,000 was saved converting RN FTE's to therapists and patient care assistants.