2004 OPEN FORUM Abstracts
THE IMPACT ON COST SAVINGS OF A NONINVASIVE POSITIVE PRESSURE VENTILATION (NPPV) PROGRAM
Lintner, RRT, Mikki Thompson, RRT, MHA, Rodney Benjamin, MD, Gale
Jackson, RRT, South Miami Hospital, Miami, Florida An affiliate of
Baptisthealth of South Florida
BACKGROUND: A review of patients on mechanical ventilation with Acute Respiratory Insufficiency or Failure (ARF) indicated that these patients had prolonged lengths of stay, consumed a disproportionate amount of ICU resources and had a decreased quality of life during their stay. The results of this review provided the impetus to develop and implement a program to apply NPPV as a first line therapy for this patient population.
METHOD: Protocols, policies and procedures, a detailed flow diagram, documentation flow sheet, clinical and equipment competency checklist were developed to permit proper implementation of NPPV. Education of respiratory staff, nurses and physicians considered critical was provided in order to assure awareness and promote teamwork, thus assuring a successful project. The protocol serves as a guideline to identify the appropriate patients, guide the titration of NPPV and use of the equipment as well as guiding triage. In the guidelines an algorithm (see Fig. 1) directs clinician activity during selection, application and management of NPPV. Ongoing data collection and evaluation, including performance improvement and benchmarking were performed.
RESULTS: Commitment of the medical director for respiratory care and emergency room physicians proved critical in the organization’s acceptance of the protocol and in the empowerment of respiratory therapists to fully implement the program. NPPV was applied in a range of settings including the ER, ICU and telemetry units. The percentage of patients receiving NPPV, relative to the total number of ventilation patients quickly rose to 44% and its utilization has stabilized at this level over the last three years. Relative to the benchmark costs, comparison of the most recent three fiscal year average for NPPV patients showed a 58% decrease in cost per case for a total savings of $11,082,855 for the three year period. Length of stay was decreased by 50%, which a reduction of 3,675 patient days.
CONCLUSION: The protocols, policies and procedures used to support our NPPV program were effective in generating significant cost savings while also improving the quality of patient care.