The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

Initiation of Mechanical Ventilation in A Pediatric Subacute vs ICU: Cost Avoidance

Racquel M. Calderon, BS, RRT, RCP; David van Stralen, MD; Patricia King, RN, BSHCS; Doug Padgett, BS; Jeff Lewis, NHA, LVN; Ravindra Rao, MD. Totally Kids Specialty Healthcare and Department of pediatrics at Loma Linda University. Loma Linda, CA.

Background: In a pediatric subacute we measure quality of ventilator management by patient comfort and safety. Additional reimbursement from third party payors covered this level of quality. The unexpected finding was the significant cost avoidance to the medical system and society.

Methods: A retrospective chart review was done on all patients admitted from 1995 to 2000 in a 50-bed freestanding pediatric subacute facility. Respiratory Care practitioners play an active role in the QI program. Indicators that are recorded include ventilator care, ventilator rounds, and documentation of ventilator adjustments. We discuss the failures and success, learning more from our failures than our successes. Failure is defined as a ventilator adjustment not standing on the first attempt or re-adjustment of ventilator settings within one week. All ventilator initiations and adjustments are tracked by the RCP and are reviewed weekly in ventilator rounds.

Results: Ventilator rounds occur on a weekly basis where feedback is given from RCPs, parents, and/or patients. As we identify the best practices, our theory of ventilator management evolved. The results were compared with the number of transfers to the acute hospital with the number of ventilator dependent admissions.

Cost comparison: The cost of care for initiating Mechanical Ventilation (MV) in a pediatric subacute is compared with admission to the Emergency Room (ER) and subsequently to the Pediatric Intensive Care Unit (PICU). Table shows the base cost of initiating a patient on MV using physician charges and daily bed rates.

  Cost of Care at Subacute Cost of Care at PICU Dollar Savings
Emergency Ambulance $0 $850.00 $850.00
Emergency Department: Room/Physician $0 $400.00/$335.00 $735.00
Daily Bed Rate $3,304.00 (4 days) $10,134.00 (3 days) $6,830.00
Physician $812.00 (3 days) $2,075.00 (4 days) $1,263.00
Total $4,116.00 $13,794.00 $9,678.00

Conclusion: Quality Improvement program with failure analysis was associated with increased initiations and adjustments with concomitant decrease in transfers to the acute hospital.


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