The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

ECONOMIC IMPACT RESULTING FROM A HOSPITAL-WIDE CONVERSION FROM SMALL VOLUME NEBULIZERS TO THE AEROECLIPSE BREATH ACTUATED NEBULIZERS

Robert S Pikarsky, BSRT, Russell A. Acevedo, MD, FAARC, FCCP, Tracey Farrell, RRT and Wendy Fascia, RRT, Respiratory Care, Crouse Hospital, Syracuse, New York.

Background: The Respiratory Department converted from a standard updraft nebulizer (SVN) to the AeroEclipse Breath Actuated Nebulizer (BAN) in 2001 and demonstrated respiratory therapist (RT) labor time savings. This assessment further explores the time saving advantages of the BAN in mouthpiece (MP) and mask mode.

Methods: All patients assessed by RT with the ability to perform aerosol treatments by mouthpiece were converted to Levalbuterol (Lev) 0.63 mg Q8h by BAN MP. If ordered, Ipratropium (Ipra) 0.5 mg was converted to Tiotropium (Tio) 18 mcg QD. If unable to perform the MP treatment patients were converted to Lev 1.25 mg Q8h via mask. If ordered, Ipra 0.5 mg was converted to Ipra 0.25 mg Q8h. All protocol treatments and delivery method (MP or mask) between 10/04 and 04/05 were recorded. BAN MP and mask administration times were measured. The SVN time was obtained from our prior time study1.The FTE average cost (salary/benefits) = $23.80/hr. The BAN cost is $4.87 each. The SVN cost was $0.78 each.

Results: The table shows the number of treatments and delivery times in each device and medication group. The combined Lev/ Ipra group had the longest administration time due to the large volume of medication. Therapist time was decreased by 534 hours or $12,704 in labor cost. The increased device cost was $8,530 for an overall cost reduction of $4,174. Estimated annual cost reduction was $10,017. The Respiratory Care Department's total expense for the first 3 months of this year was 8.6% under budget and 7.9% below the same time period in 2004. Breakthrough rates were similar in all 4 groups.

  Treat-ments Without Substitution With Substitution Difference
MP Lev 0.63 mg Q8h (n, min ) 3541 8.33 3.96 -4.37
MP Lev 0.63 mg Q8h/Tio Qday (1st dose; n, min ) 1130 10.33 5.96 -4.37
Mask Lev 1.25 mg Q8h (n, min ) 3092 8.33 5.72 -2.61
Mask Lev 1.25 mg/Ipra 0.25 mg Q8h (n, min ) 1145 12.50 8.57 -3.93
Labor SVN (hours)   1,326  
Labor MP (hours)     334 
Labor Mask (hours)     458 
Total labor difference (hours)   1,326 792 -534
Labor (dollars)   $31,550 $18,846 -$12,704
Device cost (dollars)   $1,627 $10,157 $8,530
Total cost difference (dollars)       -$4,174
Total cost difference (annualized, dollars)       -$10,017

Conclusions: The BAN is cost effective by minimizing treatment times. The mouthpiece mode had the greatest time reduction. Dosing reduction in the MP group allowed shorter administration times with similar clinical effects. The longest time was seen in the Lev/Ipra group, which can be decreased when the Lev concentrate is available. BAN is a cost-effective strategy to decrease aerosol administration time or to re-allocate of workforce needs. Using the smallest effective dose, the most concentrated medications, and using the mouthpiece mode will maximize the benefits of the BAN.

1 CHEST 2001;120(4)218S

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