2006 OPEN FORUM Abstracts
DO RESPIRATORY THERAPIST-DRIVEN WEANING ASSESSMENTS/PROTOCOLS AND THE MULTIDISCIPLINARY INTENSIVIST-LED TEAM POSITIVELY INFLUENCE AVERAGE MECHANICAL VENTILATION DAYS AND AVERAGE LENGTH OF STAY IN THE LONG-TERM MECHANICALLY VENTILATED PATIENT?
WH Phillips DHSc RRT, PR Deaton MD FCCP, BS Faulkner RRT RPFT BPS,
DL Richardson RN BS, Methodist University Hospital, Memphis, TN.
Background: Current research has shown support of improved outcomes in the intensive care units (ICUs) where the "intensivist model" is implemented. There is evidence that respiratory therapist-driven weaning assessments and liberation protocols decrease ventilator weaning time and offers significant progress toward decreasing length of stay. Our hospital enrolled in the Institute for Healthcare Improvement (IHI) Critical Care initiative in 2001. This initiative made recommendations for care in the intensive care unit (ICU) utilizing the multidisciplinary intensivist-led model to reduce comorbidity and length of stay in the intensive care unit (ICU). Patients who failed to wean from mechanical ventilation were transferred to the long-term ventilator care unit (VCU) for rehabilitation. Historically, this unit has struggled with length of stay from failure to wean resulting in decreased financial performance.
Hypothesis: We hypothesized the interventions used in acute critical care could positively impact patient length of stay (LOS) in the long-term ventilator care unit.
Methods: In September 2004, we incrementally implemented the IHI recommendations of ventilator bundle, multidisciplinary intensivist-led team and patient/family satisfaction survey to the patient care plan in the VCU. We gathered data on all 198 patients discharged from the ventilator care unit from January 2004 to June 2005. The Clinical Informatics Department provided length of stay from January 2004 to June 2005. The respiratory therapy department calculated mechanical ventilator days from July 2004 to June 2005.
Results: Ventilator days gradually decreased from an average of 13.8 days (SD 1.26) to 7.46 (SD 1.35) and ventilator care unit stay decreased from an average of 16.13 to 7.25 days (SD 3.85).
Conclusions: Respiratory therapy assessments/protocols and intensivist-led multidisciplinary team interventions positively impact long-term ventilator care unit length of stay.
(Key Words; mechanical ventilation, weaning, respiratory therapist-driven protocols, multidisciplinary team.)