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.