The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

RT-ICU RESOURCE ENHANCES MULTIDISCIPLINARY TEAM APPROACH AND IMPROVES VENTILATOR OUTCOMES: A RETROSPECTIVE STUDY 2008-2011.

Emmanuel P. Rivera1, Harleen D. Toor1, Rodolfo T. Teodosio1, Kent Joraanstad1, Steve Dring1, Kelly Franco1, Cindy Wojdon1, Carmencita Agcaoili2, Vineet Kapur2; 1Respiratory Care Department and ICU/CCU, Washington Hospital Healthcare System, Fremont, CA; 2Washington Township Medical Foundation (Intensivist Group), Fremont, CA

Evidence-based studies have demonstrated that a multidisciplinary team approach improves patient outcomes, particularly ventilator length of stay (LOS). In January 2008, a respiratory care initiative called RT-ICU resource was created to complement our new multidisciplinary and Intensivist program. The team is composed of respiratory therapists, intensivists, nurses, pharmacists, case managers, dietitians, physical/occupational/speech therapists and spiritual care coordinator. This observational study was aimed to identify and track sustainable ventilator outcomes since the inception of full-time, 24/7 coverage of RT-ICU resource and intensivists beginning January 2009. Ongoing collaborative efforts enhance process changes at bedside. METHODS: Retrospective cohort study of all adult, mechanically ventilated patients in our ICU from 2008-2011 (n=2176). A data collection team called Ventilator Outcomes Resource Team Exchange (VORTEX) created a user-friendly ventilator tracking form called the “BLUE SHEET”. Nine ventilator outcomes were examined with a focus on LOS. All statistical analysis was done using SAS (9.1.3) software. An independent t-test and Wilcoxon rank-sum test was used to test differences for parametric and non-parametric continuous variables, while a chi-square test was used for intergroup comparisons among categorical variables. DESIGN: 359-bed, community hospital in Northern California. 28-bed“open” MICU/SICU. Process improvements included: A) Daily physician-led multidisciplinary rounds. B) Development and implementation of spontaneous breathing trial protocol. C) Increased RT-ICU staffing by 0.5 FTE resulting in better unit coverage. E) Annual skills lab for physicians and ICU multidisciplinary team focusing on airway management and invasive & non-invasive positive pressure ventilation. F) Continuing education on palliative and end-of-life ventilator care. RESULTS: Mean ventilator LOS decreased significantly by 2.12 days per patient from 2008-2009 (p=0.003). Low ventilator LOS was sustained through December 2011 (Table 1). Approximate savings from 2008-2009 were $1.5 million (based on national averages). CONCLUSION: Establishing a 24/7 RT-ICU resource, integrated with an intensivist-led multidisciplinary team, is cost-effective and associated with sustained positive ventilator outcomes. Sponsored Research - None Table 1. Ventilator Outcomes 2008-2011 *Mean LOS; p=0.003 **Median LOS; p=0.001