July 29, 2005
Genesis Program Reduces Ventilator Usage By 42%
Davenport, IA - A pilot program to wean patients off mechanical ventilators saved Genesis Medical Center patients and their insurance providers more than $1.4 million in the last fiscal year and saved Genesis more than $7 million in related costs.
Using a multi-disciplinary approach and new technology to enhance the monitoring of patients, Genesis Medical Center was able to reduce the total number of patient ventilator hours by 42 percent.
Costs were reduced and the quality of patient care was improved by weaning patients from mechanical ventilators after shorter periods. The risk of complications, including infections, increases the longer a patient is on ventilation.
Genesis patients who needed mechanical ventilators received breathing assistance for an average of 68 hours in fiscal year 2005. By comparison, in fiscal year 2004, the average hours of ventilation per patient was 118.0 and the average in 2003 was 127.4 hours per patient.
Genesis Medical Center was able to realize significant savings by reducing the total of ventilation days.
Mechanical ventilation costs are high and reimbursements are often low. Mechanical ventilation costs approximately $5,000 per day, per patient but Medicare reimbursements cover only 20 percent of actual costs. Each day that a Medicare patient can breathe without a ventilator, costs to the patient and the hospital are reduced.
The decrease in ventilation days also opened critical care beds in the Intensive Care Unit and eased demands on staff. Overtime costs were reduced as a result. Another savings was documented from decreased use of equipment and decreased need for liquid oxygen used during mechanical ventilation.
The pilot program began in April 2004 on the Surgical Intensive Care Unit and was expanded to the Medical Intensive Care Unit.
Creating a ventilator weaning protocol has been a goal of Genesis Medical Center for several years. As part of Genesis’ A.C.T. (Access, Convenience and Throughput) initiative, ventilator weaning was pushed to the forefront. A.C.T. looks at ideas to increase inpatient bed capacity and eliminate bottlenecks and barriers to timely treatment.
Development of the Genesis vent-weaning initiative was aided by new technology in mechanical ventilators and new, non-invasive cardiac output monitors, or NICO. Dennis Harker, Manager of Respiratory Care, said the NICO monitors provide far more information about a patient’s respiratory condition than monitors previously used by Genesis.
“It was nice to have the support of Frank Claudy (Vice President of Medical Affairs), who understood the potential of these monitors. He could see the benefits, even at a cost of $10,000 per unit,’’ Harker explained. “Having that kind of support at the administrative level was great. The investment has paid off.’’
Harker said the NICO monitors provide more detail about the function of heart and lungs of patients on ventilators. He explained that the volume and concentration of carbon dioxide expelled by a patient can indicate whether the patient can be successfully weaned from the ventilator. “The monitors show graphically the exhalation and concentration of CO2. By those readings, we can better determine the severity of the patient’s problem,’’ Harker said. “We gather all of the information to determine whether a patient can be weaned from the ventilator.’’
Genesis adopted a protocol already implemented at Duke University Medical Center, Durham, N.C., but the capabilities of the cardiopulmonary management system available from Respironics Inc. allowed Genesis to expand on the Duke protocol.
“Genesis was able to take our protocol to the next level with new monitoring technology that was available,’’ said Mike Gentile, an Associate in Research at Duke. “The savings they experienced at Genesis are pretty remarkable, but at the same time, they improved patient care. Weaning off mechanical ventilators as quickly as possible is something that all patients and clinicians want.’’
Genesis was able reduce the number of patient days on ventilation while also maintaining low re-intubation rates. Of the patients who were weaned from ventilators by Genesis Medical Center in Fiscal Year 2005, only 1 percent had to be placed back on a ventilator. The national average of re-intubation ranges from 4 to 15 percent. Genesis had a total of 710 ventilator patients in fiscal year 2005.
“The new technology of the monitors helps us answer critical questions. Has the condition that put the patient on the vent been improved, or recessed enough that the patient can support themselves?,’’ said Mikel O’Klock, staff development coordinator for Respiratory Care. “The monitors we are using helps us do a better job of answering those questions. There is less guesswork.’’
O’Klock said vent weaning also is a patient care issue. He explained that the longer a patient is on ventilation, possible complications, including infections, become more likely. “Also, the longer a patient is on a ventilator, the weaker they become,’’ he said.
Genesis patients on a mechanical ventilator are challenged with daily spontaneous breathing trials, during which factors such as patients’ respiratory pattern, cardiovascular response and oxygenation are evaluated. The information allows caregivers to make informed decisions on the patients’ need for ventilation support.
The respiratory staff has undergone hundreds of hours of education about the protocol and when to apply it. “It’s a real team effort between respiratory therapists, the nurses and physicians,’’ O’Klock said, who has been the clinical educator on the project.
O’Klock has explained the protocol to representatives of Respironics and has prepared an abstract for a presentation before the American Association for Respiratory Care International Congress.
