The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

Effectsof a Multidisciplinary Task Force Effort to Improve the Process of Adult MechanicalVentilator Transfers Out of the Acute Care Setting

GregSandman, MD, Cathy Gilbert, RN; Matt Kilroy, BS, RRT; Joan Keith, MSW;Deb Ryan, RN; Spectrum Health, Butterworth Campus, 100 Michigan NE, Grand Rapids,Michigan, 49503.

Background:For the last several years there was a concern regarding increased time, expenseand poor coordination of mechanically ventilated patients that were identifiedas non-weanable. Medical Critical Care, Spectrum Health Butterworth Campus had880 admissions in 1999 of which 438 (49.7%) were ventilated at some point duringtheir ICU stay. Data analysis revealed that patients most likely to fail weaningfrom mechanical ventilation were those who had experienced 14 consecutive ormore in-house ventilator days. Reviewing the last four years of in-house data,there were 43 patients in 1997, 47 patients in 1998, 48 patients in 1999, and31 patients as of May 2000 that met this criteria. Trends indicate that thispatient population continues to increase and will most likely result in a significantincrease in cost, related to utilization of hospital resources, unless actionwas taken.

Objective: Todevelop and implement a comprehensive and efficient process to successfullytransfer a mechanically ventilated adult patient out of the intensive care unit.This included in-house step down units, sub acute care facilities, long termacute care facilities, long term care Ventilator Dependant Unit or the patient?shome.

Design: Key playersinvolved in the current process were identified and asked to participate ona Process Improvement Team (PIT) that would be charged with developing a programthat would help achieve the objective. Long term mechanical ventilator patientswere identified as those mechanically ventilated > or = 14 days. Monitorswere designed around this figure via Project Impact that included; percent ofventilated patients, percent of ventilated patients at the time of admission,the mean LOS of all patients, patient acuity by SAPS II score on all patients,SAPS II Z-Scores on all patients and patients ventilated > or = 14 days,and mean ICU LOS of patients ventilated > or = to 14 days. The first draftof the written program was developed by using an existing pediatric mechanicalventilator discharge program as a template and the American College of ChestPhysicians guidelines on Mechanical Ventilation Beyond The Intensive Care Unit.Chest 1998:113(suppl):289S-344S. Final drafts of the written program were completedand the process was tested immediately on those patients that met the criteria.

Results: Applyingthis program to our in-house patients as well as resolving issues early on duringPIT meetings, resulted in the LOS of these patients decreasing from a mean ICULOS in 1999 of 26.1 days to 19.9 days during the first quarter of 2001! It shouldbe noted this significant decrease in LOS occurred inspite of an increase inthe overall acuity of this patient population. (Acuity by SAPS II scores 1999= 46.7, 2001 1st quarter = 50.1) The patient, their family, and the ICU staffsatisfaction was enhanced and patient care cost were reduced as a result ofthis initiative.

Conclusion: Followinga team approach and applying a program that would immediately identify and helpinitiate a discharge action plan for potential long term mechanical ventilationpatient candidates, could significantly reduce the LOS and medical expensesfor this patient population.

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