The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

EVALUATION OF THE PREVALENCE AND COST EFFECTIVENESS FOR VENTILATOR ASSOCIATED PNEUMONIA AT A LARGE UNIVERSITY TEACHING HOSPITAL. 


Sasha Cooper BS, CRT, Jennifer Beardsley BS, CRT, Lisa Claxton BS, CRT, Deborah Cullen EdD RRT, FAARC, Respiratory Therapy Program, School of Allied Health Science, Indiana University, Indianapolis, IN, Chuck Christoph, BS, RRT, Clinical Education Coordinator, Wendy LaLone, BS, RRT, Respiratory Care Department Manager, Indiana University Hospital, Indianapolis, IN.


Background:
 Pneumonia is the second most frequent nosocomial infection in the United States, accounting for 13% to 18% of all nosocomial infections. Ventilator Associated Pneumonia (VAP) results in increased mortality and morbidity, accounts for 1.75 million excess hospital days and $1.5 billion in the United States alone. The medical costs for a diagnosed VAP patient has dramatically increased from the average of $1255 per patient in 1982 to an estimated additional cost of $40,000 per patient in 2002. Significantly, at this teaching hospital the average SICU cost is $1820 per day with a ventilator cost of $708 per day. Since no gold standard for per patient cost exists, we investigated the cost effectiveness and prevalence for this SICU population. 

Methods:
 In a preliminary study, data were collected on ventilated patients in Surgical ICU to screen for signs and symptoms of VAP. VAP diagnosis included positive results for two of the following; purulent sputum, new or progressive infiltrates on chest x-ray, fever or leukocytosis. Patients were excluded from the study if they were admitted with a previous diagnosis of pneumonia, were transferred from another hospital with VAP or had multiple re-intubations. For this analysis, data were observed from January 2003 through March 2003 to determine institutional SICU VAP rates and cost effectiveness. The institutional prevalence was then compared to the National Nosocomial Infections Surveillance (NNIS) System rate. This research noted prior Institutional Review Board (IRB) approval. 

RESULTS:
 Findings indicated a Surgical ICU VAP rate of 7.27 per 1000 ventilator days. According to the NNIS System, the most current VAP rate for Surgical ICU is 11.6 per 1000 ventilator days. When compared to national standards, the surgical VAP rate for this institution depicted a lesser incidence of VAP.

Experience: It was calculated that once diagnosed, on average, a VAP patient spent approximately 34 ± 19 additional days in SICU. The average VAP-diagnosed patient accrued costs of $6,605 ± $2,227 per day. This resulted in an average of an additional $224,577 ± $110,327 per patient, not including labor, due to VAP. Co-morbidity, case mix, and institutional type must be considered when calculating and comparing total SICU costs. 

Conclusions:
 Outcomes indicated the VAP incidence was less than the national average for this institution during this three-month period. Fewer VAP patients indicate cost savings. Institutional factors such as case-mix and co-morbidity greatly influence VAP outcomes such as length of stay and cost effectiveness. Quality assurance should be conducted to reduce and control VAP incidence.

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