DECREASED VENTILATOR LOS WITH IMPLEMENTATION OF DISEASE SPECIFIC VENTILATORY PROTOCOLS AND DECISION PATHWAYS

Alberto Marra, BS, R.R.T., Terry Miller, BS, R.R.T., Shelly Jones, R.R.T., Leanne Keiken, R.R.T., Robert Whiteside, BS, R.R.T., Mike Beebie, BS, R.R.T. Mercy Health System, Janesville, WI

Background: The most difficult and costly patients are those requiring mechanical ventilation (MV) and intensive care (ICU) for greater than 24 hours. Inconsistency in the management of ventilator dependant patients among respiratory therapists, nurses and physicians influences the length of ICU stay. To study the effects of disease specific ventilatory protocols, and decision pathways on optimizing patients' ventilatory management and hospital length of stay (LOS), we conducted the following study.

Methods: An extensive training program was implemented with the assistance of Siemens Clinical Management Program? (CMP). Disease specific ventilatory protocols and decision pathways that were used were derived from scientific evidence based practice and expert consensus. Education lectures and training were provided for staff physicians, respiratory therapists and ICU nurses. CMP stressed the utilization and efficient use of mechanical ventilation applying standard ventilators and graphic waveform interpretation as integrated in the protocols and decision pathways. A data collection strategy was developed to acquire information on patients requiring mechanical ventilation for greater than 24 hours on CMP vs. off CMP. All patients were assessed for outcomes based on severity of illness scoring (3M APR-DRG), morbidity, MV LOS, ICU LOS, hospital LOS, and cost of care.

Results: During fiscal year (98-99) a total of 284 patients were admitted to ICU requiring mechanical ventilation. 156 patients required ventilatory management greater than 24 hours. 117 patients were on CMP vs. 39 off CMP protocols. The average severity of illness for the patients on CMP was 3.1 / off CMP was 3.5 (APR-DRG). The MV LOS on CMP was 4.8 / off CMP was 5.2 (15% improvement). ICU LOS on CMP was 5.8 / off CMP was 7.2 (21% improvement). The average hospital LOS for patients on CMP was 11 / off CMP was 13 (16% improvement). Conclusion: Our results indicated that installing evidenced based disease specific ventilatory protocols, and decision pathways (CMP) showed a reduction in MV LOS, ICU LOS, hospital LOS and total cost of care in patient requiring mechanical ventilation greater than 24 hours.