The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Implementation of the STEER Ventilator Weaning Protocol

Richard Ford BS RRT FAARC, Julie Emerick RRT, Jan Phillips Clar BS RRT and Timothy Morris MD. University of California, San Diego Medical Center, San Diego California.

Background: A weaning protocol was in place since 1989, however physicians ordered the protocol in less than 30% of ventilator dependent patients. There exists a growing body of evidence based research indicating that the use of a multidisciplinary set of guidelines for ventilator management and weaning, results in a reduction in ventilator duration and ICU length of stay. We initiated a process to improve physician compliance and measured the impact on ventilator duration. Our objectives included the process of gaining formal medical staff consensus of the protocol and approval of additional personnel resources to provide oversight and multidisciplinary collaboration. If successful, we expected to achieve a decrease in expenses per ventilator patient and a net savings to the medical center.

Methods
: Over a one-year period the respiratory care team and ICU physician leadership met on numerous occasions to insure the weaning protocol was clear and understandable, and that educational and training resources were available. The protocol was refined to focus on early identification of weaning potential through the use of the rapid shallow breathing index, and criteria based advancement to spontaneous breathing trials and extubation. In the consensus building process the weaning protocol was named STEER, representing the following steps: Screen, Trial, Evaluate, Exercise, and Report. An additional FTE for RC was also approved to attend rounds, support training, and provide general oversight of the program. With the new STEER protocol developed, physicians and staff educated and new resources in place, the program was implemented. Physician compliance with the protocol was measured and the duration of ventilation for all ICU patients after implementation was compared with the ventilator duration the year prior to planning the program.

Results
: MD Compliance gradually improved post implementation period averaging greater than 90%. Pre and Post STEER ventilator duration, demonstrated a 9.3% reduction in median duration per patient, a 7% reduction in average ventilator hours per patient and a 14% reduction in overall ventilator hours.

  2001-Pre STEER 2003-Post STEER
Total Pts 1283 1190
Total Hrs 181400 155911
Hrs/Pt 141.39 131.02
Median 43 39

Conclusions: Through a consensus building process with medical staff, the provision of training, and the investment in resources to support the critical functions of coordination and communication amongst caregivers, weaning protocol compliance was improved. The resulting reduction in ventilator duration accounts for a direct cost savings for RC that exceeds $180,000 and much greater cost savings to other areas of the medical center in which resources are allocated to care for ventilator patients.

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