2009 OPEN FORUM Abstracts
IMPACT OF A BREATH ACTUATED NEBULIZER PERFORMANCE IMPROVEMENT ON HOSPITAL LENGTH OF STAY
John S. Emberger1, Joel M. Brown1, Vinay Maheshwari1,2, Lorraine Killian1; 1Respiratory Care, Christiana Care Health System, Newark, DE; 2Medicine, Christiana Care Health System, Newark, DE
BACKGROUND: Newer nebulizer technologies have been developed that may improve delivery of medications as well as shorten the duration of therapy time. We have been investigating ways that we can provide better care and eliminate concurrent respiratory therapy. A performance improvement project was approved by our Pharmacy and Therapeutics Committee, to evaluate performing one-on-one nebulizer therapy with a breath actuated nebulizer (Aeroeclipse® II, Monaghan Medical). We wanted to determine if timed breath actuated nebulizer (BAN) therapy impacted patient length of stay in the hospital. METHODS: We performed an IRB approved retrospective review of the following patient populations: 1) Patients in the BAN approved area that recieved 3 minute timed BAN treatments (BAN Patients) 2) Patients on standard nebulizers in the BAN approved area before the BAN project was initiated (PRE-BAN Patients) 3) Patients on a similar reference floor that used standard nebulizers (REFERENCE Patients). Primary end point was hospital length of stay. We excluded patients with invasive or non-invasive mechanical ventilation, tracheostomy and ICU visit. We analyzed characteristics such as: oxygen use, combination controller medication use and home bronchodilator use to determine if the populations are “like” patients. We identified each patient’s primary diagnosis and DRG code for comparision analysis. RESULTS: We identified 365 BAN patients for inclusion. The BAN, PRE-BAN and REFERENCE patients had similar percentages of the “like” characteristics listed in the methods section. There was a similar distribution of patients with COPD DRG, Asthma DRG and COPD primary diagnosis in each of the three populations. See chart for hospital length of stay analysis. CONCLUSION: Bronchodilator treatment for patients with obstructive diseases such as Asthma and COPD have conventionally used standard small volume jet nebulizers. Our study compared the use of breath actuated nebulizers versus small volume nebulizers to evaluate the primary endpoint of hospital LOS in patients with COPD, Asthma, or both. Actual treatment time was 3 minutes or less which allowed respiratory staff to eliminate concurrent therapy. Treatment with BAN resulted in a statistically significant reduction in hospital LOS when compared to historical reference and concurrent reference patients with COPD and Asthma. Wider prospective studies to evaluate this therapy are needed. Sponsored Research - None
* p < 0.05 BAN to PRE-BAN and BAN to REFERENCE.
PRE-BAN to REFERENCE was not statistically significant (p > 0.05)