The Science Journal of the American Association for Respiratory Care

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.

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