2004 OPEN FORUM Abstracts
ADULT MECHANICAL VENTILATION PROTOCOL EVALUATION
Kara McIlvain RRT, Paul Luehrs RRT, Zach Frazier RRT CoxHealth
Springfield, MO
Background
The goal for the CoxHealth Respiratory Therapy department was to
develop an efficient, patient driven protocol to improve clinical
outcomes, decrease lengths of stay, decrease health care costs, and
increase clinician and patient satisfaction.
Method:Ventilator hours per setup, length
of hospital stay, and Ventilator Associated Pneumonia rates (VAP)
were used as our determinants for the study. Data representing VAP,
Hospital Length of Stay (LOS) for
the selected Diagnostic Related Groups (DRGs), and ventilator hours
per patient were collected pre protocol implementation and post
protocol implementation.
Results: Data monitoring from 2000 through 2002: Ventilator hours
decreased from an
average
of 200 to 130 hours per adult ventilator set-up. VAP rates in
the Medical Intensive
Care
Unit (MICU) decreased from 2.7 to 0.87 pneumonias per 1000 adult
ventilator days,
significantly
less than the national average of 5.5. LOS for our DRGs fell from
19.8 to 15.3
days,
representing a decrease in hospital charges of approximately $4.5
million per year. The effectiveness of our program has been proven
with a 34% decrease in the number of ventilator
hours, 68% decrease in VAP rates, 23% decrease in the hospital LOS in
the study DRGs,
and
improved patient satisfaction with early extubation. As an added
benefit, our respiratory
staff
reported increased job satisfaction and improved collaborative
working relationships with nurses and physicians.
| Indicator | Pre-protocol | Post-protocol | % change |
| Ventilator Acquired Pneumonia | 2.7/1000 vent days | 0.87/1000 vent days | -68% |
| Ventilator hours/patient | 200 hours | 130 hours | -34% |
| Average hospital length of stay | 19.8 days | 15.3 days | -23% |
Conclusions: Implementation of the comprehensive ventilator
management protocol within the adult intensive care units resulted in
a decreased length of stay of 4.5 days and represented a decrease in
hospital charges of $4.5 million per year. A decrease of 1.83
nosocomial pneumonias per 1000 adult ventilator days and a decrease
of 70 ventilator hours per patient also influenced savings for the
hospital system.