The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

THE VENTILATOR MANAGEMENT INITIATIVE: REDUCING COSTS AND LENGTH OF STAY IN MECHANICAL VENTILATOR PATIENTS.

John Sabo, Joy K. Hargett, Mary Curnyn, Elizabeth Bearden, Doug Wheeler, Margie Doty; Respiratory Care, St. Luke’s Episcopal Hospital, Houston, TX

Background and Method: The mechanically ventilated patient population is the most critical and requires extensive resources to treat. In 2008, our facility treated 3,314 ventilator patients with an average total cost of $61,127. A Ventilator Management Initiative (VMI) team was developed, including respiratory therapists, nurses, pharmacists, case managers and physicians. This multidisciplinary team was facilitated by the Administrative Director of Respiratory Care. Utilizing the LEAN process the root causes identifying opportunities for improvement were targeted. These opportunities included standardization of care, interventions between disciplines, variability in skill levels, communication and discharge process. Actions items to address these opportunities included development of a physician order set that standardized the ventilator bundle. This utilizes options for ventilator management, sedation management, and DVT and PUD prophylaxis. An extensive education program was conducted to all ICU nursing and respiratory care staff. Case management enhanced the throughput of this patient population. The ventilator population was divided into two categories. The Ventilator Product Line included DRG’s, 541, 542, 565, 566, and 575. The second category was comprised of the remaining DRG’s of patients requiring mechanical ventilation. Due to the complexity of the patient population, we focused primarily the VMI on the Ventilator Product Line DRG’s. The measurement matrix included Length of Stay (LOS), ICU LOS, Progressive Care Unit (PCU) LOS, Length of Ventilation (LOV), Total Cost/Case, and Case Mix Index(CMI). Conclusion: Comparing 2008 and 2009 data after the institution of the VMI program, there were decreases in LOS, ICU LOS, PCU LOS, LOV, and Total Cost with an increase in CMI in the Ventilator Product Line DRG’s. We also saw decreases in the total ventilator population, PCU LOS and LOV in the remaining DRG patients. Currently the next phase of the initiative will focus on enhancing communication to the physicians via electronic means for all ventilator patients. This incorporates a three phase approach utilizing electronic ventilator documentation to increase efficiency, branching logic software to standardize therapist critical thinking skills and an interface to the physician and nursing medical records reporting the progress of the weaning process. Sponsored Research - None