2005 OPEN FORUM Abstracts
DECREASING POST-OP WEANING TIME: A MULTI-DISCIPLINARY APPROACH.
Smith GW BS RRT*, Dramse D BS RRT, Reyes H RRT, Anderson A MSN RN, Luppes S RRT, Rowley J RN, Hookstra D RN CCRN, Kresnick K MSN, RN, Rohlfs S MA RN, Olson C MD, PetersonJ MD, Jacobsen P MD,Fristoe L MMS CCP and Dorheim T MD. Nebraska Methodist Hospital, Omaha, Nebraska (*at the time of the study, Mr Smith worked at Nebraska Methodist Hospital; currently he works at Great Plains Regional Medical Center, North Platte, Nebraska)
Background: Hospitals are continuously evaluating their processes to ensure the best outcomes for the lowest cost. Advances in ventilation modes, respiratory care and nursing practice, along with improved surgical and anesthetic techniques raises the question as to whether it is still clinically indicated and fiscally sound to keep patients intubated and in the ICU for postoperative care. The purpose of this study was to evaluate early extubation as part of a fast-track surgical program and the effect on postoperative outcomes, continuity of care, and length of stay (LOS) against the 2004 national averages established by the Society of Thoracic Surgeons (STS) database.
Methods: All patients that underwent coronary artery bypass surgery from September 2002 through May 2005 were eligible for the study. Cardiopulmonary bypass and preoperative risk factors were not exclusionary criteria. All patients were placed on the Draeger Evita ventilator utilizing the MMV mode and a rapid weaning protocol. Upon extubation, patients were placed on an activity protocol and a post extubation protocol in the recovery room. Patients were transferred to the Cardiac Floor when discharge criteria were met, instead of ICU. Respiratory care and nursing resources were matched per patients needs. All patients were placed on Respiratory and Nursing patient driven protocols.
Results: Seven hundred forty six coronary artery bypass patients participated in the fast-track program. Mean intubation time was 3.84 hours for patients at Nebraska Methodist Hospital (NMH) compared to STS mean of 16.8 hours. Reintubation rates were 4% compared to STS rate of 3.7%.Mortality rate was 2.8% compared to STS rate of 2.4%. Mean postoperative LOS for fast-track patients was 5.43 days compared to STS mean LOS of 6.9 days.
Conclusion and Implications: Early extubation with the Fast-track program improved continuity of care between team members, improved postoperative outcomes, decreased postoperative length of stay and allowed for respiratory and nursing patient driven protocols. Early extubation did not contribute to reintubation 24 hours post-op or overall mortality.