The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A MULTIDISCIPLINARY SOLUTION TO DECREASE THE LENGTH OF STAY OF THE VENTILATED PATIENT

Sally Whitten1, Sonja Orff-Ney2, Nicole Manchester2, Wilkins Shelly2, John Dziodzio1



Background: To address an increase in the number of patients on the ventilator for over 21 days, we developed a strategy to improve quality outcomes, decrease length of stay, augment patient and family-centered care, as well as earlier identification of admissions into the Assisted Ventilation Program (AVP) for ventilated patients at Maine Medical Center.

Methods: A multidisciplinary team was created with representation from nursing, respiratory therapy, physical therapy, pastoral care, dietary, social work, palliative care, pharmacy, clinical ethics, mental health, and physicians. Multidisciplinary rounds occur weekly in the Special Care Unit (SCU), Cardiothoracic Intensive Care Unit (CTICU), and Assisted Ventilation Unit (AVU) on patients who have been on the ventilator for greater than 5 days. A core group, consisting of two Clinical Nurse Leaders and a Unit-Based Educator, share responsibility to coordinate and facilitate rounds. Each patient's clinical story is presented to the multidisciplinary team, with input from the bedside nurse, respiratory therapist, patients and families. The team provides recommendations to the patient's primary medical team, and twice weekly the core group, with the bedside RN or the primary team, assesses whether recommendations were followed. To evaluate changes during this study, we collected ICU length-of-stay (LOS), AVP LOS, ventilator-days, and number of returns to ICU in the intervals preceding and following the implementation.

Results: In the 24 month interval prior to implementation, 78 patients were admitted to the AVP; in the 24 months following, 45 patients were admitted. Earlier identification of AVP patients resulted in decreased ICU Length of Stay (LOS) from 32.5 days to 25.4 days, a drop of 21.8% (P=0.13). We also noted a decrease in rate of return to ICU from the AVU, from 13.2 to 8.2 returns per 100 cases, a drop of 38.0% (P=0.39). Ventilator days decreased 17.0%, from 53.3 to 44.3 days (P=0.17).

Conclusion: The wide variability in the data yields large standard deviations from the mean, precluding our ability to demonstrate statistical significance in the large percentage changes we calculated. Since the implementation of the team, no patients have been transferred to a long-term acute care facility. We have noted improved communication between health team, patient & family, improved coordination of care, and improved multidisciplinary consult initiation time.