2001 OPEN FORUM Abstracts
APNEAMONITOR MANAGEMENT ALGORITHM AND DEDICATED STAFF REDUCE LENGTH OF MONITORINGAND DECREASE COST OF CARE
James StegmaierRRT, RPFT, CCM, Joseph Lewarski BS, RRT, Madelyn Dougherty LPN Hytech Homecare, Cleveland, Ohio
Background: Infant cardiorespiratory(apnea) monitoring has been used in the home management of high-risk infants(infants thought to be at risk for sudden death or rapid cardiorespiratory compromise)for nearly 3 decades. Despite its long tenure, there is no standardized caremodel for the planned discontinuation of monitors. The last nationally publishedconsensus statement specific to this topic was printed in 1986. Technologicaladvances in infant monitoring devices have lead to newer, very sophisticatedmonitors with full-disclosure memory systems, compliance tracking, and downloadableevent waveforms. Historically, high-risk infants were monitored for extendedperiods (>6 mos. to 1 year) and caregiver history of symptom resolution theprimary deciding factor for monitor discontinuation. High-risk infants are nowcommonly divided into two categories: non-technology dependent-symptomaticinfant (idiopathic apnea of prematurity, apnea of infancy, etc.) and technologydependent infant (requires oxygen, tracheostomy, ventilation, etc.). Itis the accepted standard of practice to monitor technology dependent infantsuntil their technology needs are eliminated (i.e., weaned from oxygen). No suchstandard exists for non-technology dependent infants. Therefore, we developeda management algorithm based on current published information, the technologicalfeatures of the Healthdyne 970 series infant monitor, and the state of OhioMedicaid coverage rules.
Method: In mid-1997 we developedan apnea monitor management algorithm for non-technology dependent infants.It is structured around scheduled monthly home visits and the use of regulardownloads to quantify the resolution of symptoms (prolonged apneas, bradycardias,etc.). From 1997-1999 we saw average monitoring periods decrease from ~7 monthsto 5 (4.64) months. Despite the presence of the algorithm, clinician workloadsoften prevented strict adherence to the protocol. In 2000 we assigned one full-timeclinician to manage the infant monitor program. This included patient follow-upand physician communication. We used 1998 as our control period and 2000 asour study period. All non-technology dependent infants on monitors wereincluded in the study group. All study patients were seen monthly and downloadswere performed as per the protocol.
Results: The mean lengthof monitoring decreased from 4.64 months in the control group (n = 52) to 2.83months in the study (n = 86), yielding a 39% reduction in mean monitoring time.Eighty-four percent (84%) of the patients in the study group had their monitorsdiscontinued in <120 days, compared to 48% in the control. Although downloadsincreased by 13% in the study group, this was predicted considering that thedownload is the primary data used to confirm the absence of symptoms. The average2-month reduction in monitor use reduced the cost of care in the study groupby $500 per patient or approximately $43,000 annually (based on the Ohio Medicaidallowable of $250/mo.).
Conclusion: The use of anapnea monitor management algorithm, along with dedicated clinical staff, demonstratesa significant reduction in home apnea monitor lengths of utilization in non-technologydependent infant monitor patients. Additional study is needed to developuniversally accepted home infant monitoring discontinuation practices.