The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Michelle P. Herrera, Gary R. Lowe, Randy Willis; Respiratory Care Services, Arkansas Children’s Hospital, Little Rock, AR

Introduction: Respiratory Care Departments are very cost conscious and frequently looking for ways to increase efficiency and reduce waste. Cool mist (CM) administration by hood is ordered by our ENT Service for patients after undergoing upper airway surgery (UAS) to reduce mucosal edema. Anecdotal observation by staff led to discussion regarding this practice as CM devices were observed not being used. CM via hood is on the pre-printed order set we use, and is checked by the MDs to be set up on most patients following UAS. We investigated CM set-up and utilization to determine if this practice could be modified. Methods: Initial data collection included a retrospective review of patients undergoing UAS to determine the scope of the issue. Between 1/11–6/11, ~900 patients underwent UAS (tonsillectomy and adenoidectomy) at our institution. Upon completion of this review, prospective data collection was undertaken to obtain a data set with current information regarding set up and patient utilization. Data were collected from 11/11–3/12. CM costs were determined, along with time spent cleaning reusable equipment. Charge capture rate was also reviewed. Results: Prospective data was collected on 86 patients. Average age was 62.8 months (range = 2 months-17 years) and average time spent in post anesthesia recovery unit (PACU) was 69.1 minutes (range = 15-178 minutes). Data revealed that 61 (70.9%) patients had CM ordered, but only 9 (14.8%) used the CM of which 3 (4.9%) used CM long enough to generate a charge (>1 hour). Interestingly, 81 (94.1%) patients received CM in PACU. Discussion: The data collection revealed very little CM utilization once the patient was discharged from PACU. Extrapolating the data to an annual basis, ~1800 patients would undergo UAS. Utilizing the results of the data sample, there would be ~1275 (70.9%) CM set ups but only ~190 (10.4%) patients would use CM and charge recapture would only occur on ~62 (3.5%) patients on an annual basis. The cost of expendables and labor cost in cleaning is ~$13.00 per set up. This results in a total expenditure of > $14,000 per year in costs for patients not utilizing CM devices. This information will be utilized in discussions to consider elimination of CM as an option from the pre-printed order sets. The goal will be to determine a more appropriate alternative in ordering CM devices as needed for patients that truly require this intervention versus ordering on most patients as is current practice. Sponsored Research - None