2000 OPEN FORUM Abstracts
TEAM WORK RESULTS IN REDUCTION OF TIME ON MECHANICAL VENTILATION FOR PATIENTS UNDERGOING OPEN HEART SURGERY
Dilshad Merchant MS, RRT, Morton Plant Hospital, Clearwater FL
BACKGROUND: In 1993 a multidisciplinary group was formed to improve the care provided to patients after open heart surgery. The manager of Respiratory Care Services led the group which consisted of cardiac surgeons, anesthesiologists, nurses and quality management professionals. Current practice was reviewed and compared to 'best practice' according to available literature. The team agreed that process changes could reduce the time patients were on mechanical ventilation after open heart surgery.
METHOD: All patients undergoing cardiac surgery were included except patients who remained on mechanical ventilation for >24 hours. Respiratory therapists kept a log of the time patients were admitted to the cardiac surgical intensive care unit and the time patients were extubated. Anesthetics/narcotics were modified. Nurses refrained from sedating patients who were waking up so that they could be weaned quickly. Patients were weaned using the protocol approved by the committee. Mean ventilator hours were reported every month to the committee. Respiratory therapists were recognized periodically for their success. Each time the mean showed an increase the team analyzed the root cause and resolved the problem. Utilization of arterial blood gases and reintubation rates were tracked.
RESULTS: Changes in anesthesia practice, support of cardiac surgeons and involvement of nurses resulted in decrease of ventilator hours from 16.3 to 3.4. Utilization of arterial blood gases after open heart surgery was reduced from 6 per patient to 2 per patient. Therapists on all shifts developed enthusiasm as they saw results and received recognition from hospital management. Reintubation rates improved and the potential of complications was reduced. Total length of stay decreased from 12 to 8 days. Managed Care favored our institution and volume increased from 574 per year to 883 patients in 1998.
CONCLUSION: Respiratory therapists can make a difference to cost and patient care. Protocols supported by medical staff and nursing are essential but commitment to process improvement by the entire team is most important. Data collection and tracking provide visual feedback of success and motivates caregivers. (See Original for Figure)