The Science Journal of the American Association for Respiratory Care
BACKGROUND: We previously reported (Am J Respir Crit Care Med 1998;157:A18) hospital outcomes of the first 212 patients managed in the Respiratory Special Care Unit between its inception (August 22, 1993) and August 13, 1997. To assess whether clinical outcomes have remained consistent over time thereafter, we assessed our experience with an additional 101 ReSCU patients admitted between August 14, 1997 and April 5, 1999.
Methods: Features of the ReSCU include 6 private beds on the pulmonary specialty ward staffed by nurses with special pulmonary and rehabilitation expertise, 24 hour respiratory therapy supervision, non-invasive monitoring (continuous pulse oximetry, end tidal capnometry, and ventilator alarms) with signal output at each bedside and at a central monitoring station, a multidisciplinary approach involving dieticians, physical therapists, and speech pathologists. Eligibility criteria have been consistent since the ReSCU opening and include hemodynamic stability, absence of an arrhythmia requiring telemetry, and, in the attending physicians' judgement, the ability to benefit from the ReSCU. Admission priority was given to patients who are deemed weanable, with all patients referred to the ReSCU from intensive care units in our institution.
Results: Between August 14, 1997 (when the prior series closed) and April 5, 1999, 101 additional ReSCU patients have accounted for 114 total ReSCU admissions. Of these 101 patients, 89 were admitted to the ReSCU once, 11 twice, and 1 three times. As in the prior series, most current patients were female (54% vs. 55%). The mean (± SD) age of current patients was 66 (± 13) years. Overall, recent outcomes are similar to those in the first 49 months of ReSCU operation. Specifically, compared to prior experience, the rate of hospital survival in the current series was 80% (vs. 82% in the prior series). Among the 81 current survivors, 55% achieved complete ventilator independence (vs. 60% previously), 20% required complete ventilator dependence (vs. 13%), and 7% required partial ventilatory support (vs. 9%). The mean (± SD) length of ReSCU stay for these 101 patients was 16 days (± 13) vs. 23 days (± 21) previously. Finally, ReSCU days accounted for 38% of the total hospital length of stay.
Conclusions: 1.Clinical outcomes in a cohort of ReSCU patients admitted since August 14, 1997 are similar to those previously described for the first 49 months of ReSCU operation. These outcomes indicate a high rate of hospital survival and, among survivors, a high rate of achieving ventilator independence. 2. These outcomes were preserved with a shorter mean length of ReSCU stay than before. 3. Attainment and maintenance of these outcomes likely reflects a consistent application of selection criteria by a stable group of attending physicians, and consistent patterns of care by a stable group of nurses, respiratory therapists, and other allied health providers.