2004 OPEN FORUM Abstracts
THE IMPACT ON COST SAVINGS OF A NONINVASIVE POSITIVE PRESSURE VENTILATION (NPPV) PROGRAM
Maureen
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.