The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


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