The Science Journal of the American Association for Respiratory Care
Very little has been reported in the medical literature regarding the financial effect of caring for stable ventilator dependent patients and other patients needing intensive respiratory in a special unit other than an intensive care unit (ICU). At our institution, St.Mary's Hospital/Mayo Medical Center, a special unit was opened on January 1, 1990, to house chronic ventilator dependent patients (CVDU). The purpose of the unit was to either wean the patient from the ventilator or train the patient and the caregivers to provide home airway and ventilator care. In 1994 the size and mission of this unit was expanded to permit the care of non-invasive ventilator patients and tracheostomy patients requiring consistent and adequate airway management outside of an ICU. During the period January 1, 1993 through December 31, 1998, 964 patients were admitted to this unit for 12,075 patient days of care. Of the total, 420 were ventilator dependent with tracheostomies, 339 were admitted for establishment of and training in non-invasive ventilation or for intensive airway/tracheostomy and respiratory care. 49% of the patients were admitted from four major surgical ICU's (thoracic and vascular surgery, emergency room/trauma/general surgery, cardiovascular surgery and neurosurgery). The remainder of the patients were transferred from the medical ICU and the coronary care unit. Another 205 patients on home ventilators and/or with chronic tracheostomies, were admitted directly to the CVDU.
We carried out a cost analysis of the various ICU's, that transferred patients to the CVDU by year from 1993 through 1998. In addition costs for the CVDU were established by year for the same period. Both direct and indirect costs were identified. We then calculated the cost effect of transferring these patients for care from high cost ICU's to the lower cost CVDU. The cost savings for the six years was calculated for each ICU transferring patients to the CVDU. During the six years of this study $4,832,551 in patient care costs were saved by moving patients from ICU's to the CVDU ($3,183,029 in savings was realized in invasively ventilated patients and $1,005,574 in the care of non-invasive ventilator patients and tracheostomy patients requiring consistent and adequate airway management outside of an ICU). The cost savings on 205 patients directly admitted was $643,948. In addition, the rate of successful liberation from the ventilator and survival was calculated for all ventilator dependent patients. These data will be presented in details