1998 OPEN FORUM Abstracts
Utilizing Weaning Protocols to Reduce Costs
Dean Hess, PhD, RRT Assistant Professor of Anaesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital Boston, MA
Guidelines, protocols, and pathways have become very popular in the 1990s. Guidelines describe the most appropriate care based upon the available evidence, pathways define the best practice along a specific timeline and provide a framework for data collection and documentation, and protocols dictate specific instructions for clinical care. Guidelines, pathways and protocols have been applied to ventilator management and weaning from mechanical ventilation. Keys to development of effective guidelines and protocols include: evidence-based, multidisciplinary input and consensus, disseminated for peer review, unambiguous text, introduced by clinical champions, evaluation of effectiveness (CQI), and updated on a regular basis. Successful use of protocols during mechanical ventilation have been reported for arterial blood gas measurement, noninvasive ventilation, acute respiratory failure ventilator management, and weaning from mechanical ventilation. An important study (Ely et al, N Engl J Med 1996; 335: 1864-1869) reported that a protocol for assessment of weaning readiness by respiratory therapists resulted in decreased ventilation days, ICU cost, and complications. Another study (Kollef et al, Crit Care Med 1997; 25: 567-574) reported that a protocol implemented by respiratory therapists and nurses resulted in weaning patients safely and more quickly than traditional physician-directed weaning. Guidelines and protocols can be used effectively for ventilator management, including weaning from the ventilator.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.