The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

IMPACT OF INCREASED STAFFING AND DEDICATED RESPIRATORY TEAM ON LIBERATING PATIENTS FROM MECHANICAL VENTILATION.

John S. Emberger, Francis Gott III, Lori Killian, Joel M. Brown II, Melani Murphy; Respiratory Care, Christiana Care Health System, Newark, DE

BACKGROUND: Our 22 bed surgical/shock/trauma intensive care unit (SICU) has frequent ventilator transports that pull RCPs away from the bedside. Our entire staff previously rotated through our SICU, which may have contributed to reduced continuity of care and less RCP interaction with the SICU physicians. In an effort improve care in SICU for ventilated patients, we increased respiratory staffing to cover transports and dedicated a team of RCPs to the SICU. We wanted to determine if increased staffing with a dedicated team would result in improved outcomes for liberating ventilator patients. METHODS: A performance improvement pilot including a dedicated SICU team with increased staffing was approved by administration. We began to monitor SICU for changes in ventilator outcomes. The monitored metrics in SICU included: ventilator patients, ventilator days, average time on the ventilator, performance of spontaneous breathing trials (SBT), RCP attendance of physician rounds and timing of extubation orders. We collected data for the 3 months prior to the pilot (PRE) Nov 2010 - Jan 2011. We also collected data during the pilot (March 2011 into June 2011). IRB approval was granted to collect the data from the electronic medical record. RESULTS: With the dedicated SICU team including increased staffing to cover SICU ventilator transports, RCPs attendance of physician rounds increased from 48% (PRE) to 100% three months into the pilot. Percentage of patients getting an SBT that meet criteria rose from 65% (PRE) to 100% three months into the pilot. Average number of ventilator days per patient has decreased from 6.4 days (PRE) to 4.5 days three month into the pilot. The percentage of extubation orders written before 11 am, as well as the percentage of orders written by the end of day shift have increased (see chart). The median time that extubation orders are written has moved from ~ 12:30pm (PRE) to ~ 10:00 am three months into the pilot. (see chart). CONCLUSIONS: A dedicated SICU team with staffing coverage for transports has resulted in: 1)increase RCP attendance of physician rounds 2)increased numbers of SBTs performed 3) a trend of reduced ventilator days per patient and 5) extubations being ordered earlier in the day. For a large SICU with frequent ventilator transports, a dedicated team with staffing for transports will enable better communication between RCPs and physicians on rounds and more efficient ventilator liberation efforts.
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