The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts


Chuck Ramirez, BA, RRT
John C. Lincoln Health Network 250 E. Dunlap Phoenix, Arizona 85020

Background: Over the coarse of three years we recorded admission data form patients given SVN therapy in the emergency department. Each year we implemented a new process on
specific months to evaluate the impact on admission rate. Documenting the resulting number of admissions from those patients receiving SVN therapy. Each year we varied the equipment or process. The goal was to identify a process change that could ultimately keep patients from getting admitted.

Method: The data was collected from two fiscal months. December and January of our winter period was used each year for the evaluation period. The admission rate from Dec./Jan. of 2000 and 2001 were used as our benchmark. 353 patients received at least one SVN. 162 patients were admitted resulting in a 46% admission rate. All patients utilized a Micro Mist nebulizer from Hudson RCI. This was used as our benchmark admission rate.

Results: First evaluation; change the type of nebulizer currently in use. We chose a nebulizer that was not too expensive. But had better delivery rating than what we were currently using. The first trial was done with a VixOne from Westmed. This nebulizer was used exclusively in the ED for two consecutive months, Dec./Jan. of 2001/2002. The admission rate for this time period was 44%. Second evaluation; we implemented a one-hour nebulizer treatment utilizing a MiniHEART Hi-Flo from Westmed. This process differed from our first trial in that we did not use the MiniHEART exclusively. The physician would identify patients that were experiencing significant bronchospasm. Those patients would receive a one-hour multiple dose SVN treatment. All other patients would receive an SVN utilizing a Micro Mist from Hudson (nebulizer used in our bench data). The admission rate was 33%. Third evaluation; during the 2003/2004 season we continued to use the one-hour MiniHEART Hi-Flo nebulizer. The change was in our conventional nebulizer. All non one-hour nebulizer treatments were given with a high density nebulizer, NebuTech HDN from Salter Labs. Incorporating a high density nebulizer with the one-hour treatment might result in improved admission rate over the MiniHEART alone. This time period had an admission rate of 39%. During this trial there was also a decrease in the number of one-hour nebs from the previous time period. One-hour continuous nebulizers dropped from 70 in previous trial to 40. Conclusion: This trial suggested that when treating ED patients with significant bronchospasm. A one-hour continuous nebulizer treatment had better results in reducing admission rate. Using more expensive high delivery/high density nebulizers did not appear to impact admission rate as significantly as the one-hour continuous treatment.