2006 OPEN FORUM Abstracts
THE STEER VENTILATOR WEANING PROTOCOL: SIX YEARS LATER
Julie
Emerick RRT, Kori Menzies RRT,
Richard Ford BS RRT FARRC, Carol Mihailuk RRT, Timothy Morris MD.
Background: We have previously reported our experience with the
STEER weaning protocol which was implemented at UCSD medical center in the latter
part of 2000. The early gains included a 10% reduction in mean hours; a 6 % reduction
in median hours and; 75-80% MD compliance. In 2002 the protocol was revised and
re-named STEER which is an acronym which defines the steps of the weaning
assessment process as: Screen, Trial, Exercise, Evaluate, and Report.
Methods:
To determine the number of patients ventilated and the duration of
mechanical ventilation, data was extracted from the CliniVision RCMIS in which
the RCP's entered ventilator data manually using point of care devices. Period
of data collection included January 1998 through April 2006. Mean durations of
mechanical ventilation were determined prior to and after implementation of STEER.
Results: Pre protocol ventilator average duration 3
years prior to STEER = 147 hours. Post protocol ventilator average duration 5 years
after implementation 127 hours. This represents a 13.6% decrease in mean
duration of ventilation per patient
Conclusions:
Since June 2001 over 850,000 hours of ventilation have been provided. Using the
direct variable labor and supply costs of managing ventilator patients, the
13.6% reduction in duration per patient is associated with an estimated
$471,648 over the 5 year period post protocols. Future enhancements to minimize
the duration of mechanical ventilation at UCSD include:
- Development of point of care automated weaning software
- Examining the utility of using respired volumetric CO2 as an indicator of readiness and toleration of weaning
- Partnerships with LTAC's and others that specialize in care of the long term ventilator patient