2000 OPEN FORUM Abstracts
COST EFFECTIVENESS -- PROTOCOLS FOR VENTILATOR MANAGEMENT
Gordon Turner, MD; Homer Engert, RRT; Laura VanHeest, RRT Saint Mary's Mercy Medical Center, Grand Rapids, MI
BACKGROUND: Outcome improvement for mechanically ventilated patients in a 14 bed mixed critical care unit and all patients in an adult intermediate unit was undertaken in 1998. We demonstrated a 39% reduction in the LOS on the ventilator; however total patient stay in the hospital and costs remained essentially unchanged. We continued to seek improvements and to lower the overall cost of care for these patients.
METHOD: Our multi-disciplinary team continued to refine our process and we implemented several Lung Protection Strategies: PCV or volume targeted Pressure Ventilation, Alveolar Recruitment, PEEP Protocol and earlier Prone positioning. We analyzed all patients who spent time in our critical care unit for utilization of resources and cost of care, comparing fiscal years 1998 to 1999. We divided the patients into two major groups: (1) mechanically ventilated and (2) those who did not require mechanical ventilation. We analyzed the Direct Variable Costs utilizing the hospital's TSI software for both groups of patients. Additionally, we scrutinized the Net Margins for these cases to account for any cost shifting away from variable costs that may have occurred.
Results: Patients receiving mechanical ventilation had Direct Variable Costs that were reduced by an average of $1,427 per case representing a total savings of $519,000 for the year. Also the Net Margins increased by 30% for this same group indicating the absence of any cost shifting. Variable Costs did not improve for patients in critical care who did not require mechanical ventilation and their Net Margins declined. Preliminary data for 2000 illustrates sustained savings.
EXPERIENCE: Our efforts which emphasized considerable autonomy for the respiratory therapist and the use of consistent protocols appears to have resulted in improved cost effectiveness for patients who require ventilator support in our hospital. The comparison group of patients who were not impacted by the protocols or focused improvement efforts showed no cost savings during this same time period.
Conclusions: Positive outcomes can be attributed to teamwork, focused CQI efforts and greater involvement of the respiratory therapist in the management of the mechanically ventilated patient. The advantages of implementing strategies to limit the time a patient must spend on the ventilator and protect the lung during that time can be demonstrated through cost analysis. Our hospital spent $519,000 less to care for 364 mechanically ventilated patients in 1999 than we would have utilizing our historical (1998) practices for this patient type. Cost improvements were seen in the group we targeted and not realized in other patients in the same unit during the same time period.