The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

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

Joy K. Hargett, John S. Sabo, Mary Curnyn; 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. Since 1997, our facility has instituted ventilator management initiatives divided into distinct phases in a relentless pursuit of improvement of outcomes related to this population. During each phase, program objectives were developed and staff training for all caregivers was implemented. Results of the program were shared with all caregivers. The major objective of the program was to reduce Ventilator Associated Pneumonia (VAP). Results: Significant reductions in both ventilator associated pneumonia and ventilator length of stay were seen consistently over time. At the beginning of our project in 1997, 149 patients had VAP for a rate of 8.97 (rate per 1000 ventilator days). At that time we initiated a pneumonia protocol and by 2000, the VAP rate dropped to 3.8. In 2005, after initiation of the ventilator bundle the rate dropped again to 1.2. Slight increases in the VAP rate from 1.2 in 2005 to 1.5 in 2008, led to initiation of a ventilator management initiative with focused concentration by all disciplines caring for this population. In 2011, only 13 patients had VAP for a rate of .81. Year to date in 2012, only 1 patient has had VAP for a rate of .37. The estimated cost of VAP in 1997 exceeded $4.2 million dollars compared to $199,000 in 2010 & $365,000 in 2011. During the 2011 phase, the Ventilator Management through Informatics phase coupled the use of Bridge-Tech Medical Technology application and Mediserve Respiratory Information Management documentation system “branching logic.” This contributed in decreasing the length of ventilation (LOV) from 5.6 days in 2010 to 4.6 days in 2011 or 17.8%. Conclusion: Over the years, an organized approach to reduce ventilator associated pneumonia had a profound effect on decreasing ventilator length of stay. This use of technology coupled with staff acceptance and education, performance goal setting and an integrated caregiver approach has allowed us to achieve success in both important metrics. Sponsored Research - None Ventilator Management Phases