The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Frank D. Sandusky, Douglas Laher; Respiratory Care, Fairview Hospital, Cleveland, OH

Background: In 2009, a Financial Performance Improvement was initiated to maintain quality, while at the same time to reduce operational cost. After reviewing all Respiratory processes, we determined that the most effective way to achieve this goal was to have patients on mechanical ventilation started on Heat and Moisture Exchanger (HME) rather than active humidification . Method: Review of the literature indicated that Heat and Moisture Exchanger (HME) could be effective longer than 24 hours of use. Several manufactures also indicated that their device could be utilized up to 48 hours.2 Our institution had used ventilators with (HMEs) on open heart patients in the past. While the average ventilator length of stay (VLOS) for these patients was less than 4 hours, 72% of all medical/surgical ventilator patient’s VLOS was 72 hours or less. We hypothesized that if we could utilize HMEs on patients for the initial 48 to 72 hours there, would be a significant cost savings. Criteria, based on current acceptable standards of practice, were established for use of the HMEs.2 Active humidification would be utilized on patients that did not meet the criteria. Also, criteria were developed to replace the standard HME with a HME with a bypass for ventilator patients receiving Meter Dose Inhaler or Aerosol therapy.3 Results: The original projections were base projected data for 2008. The projected volume for 2009 was 870 patients accounting for 3,100 days of mechanical ventilation. The program was started on January 1st, 2009, with a cost savings goal of $14,000. The actual cost saving for the total year was evaluated in January 2010. While mechanically ventilated volume was a significant above budget for 2009, our cost saving fell below plan. It is suspected that this difference came as a result of increased use of the HME with bypass and more frequent HME change-outs then forecasted. Even with the initial problems encountered we realized a $12,187 cost savings for 2009. Conclusion: Therefore, starting the patient with a HMEs or HMEs with a bypass system is cost effective. As with any cost saving proposal or change in therapy procedure it is very important to monitor outcomes. Although, we did not meet our goal, we did have a significant cost savings and maintain quality of care. Sponsored Research - None