Respiratory therapist driven ventilator management decreases length of mechanical ventilation
Introduction. The health care industry as a whole has been asked to take a close look at the utilization of health care resources. The Department of Pediatrics along with the registered respiratory therapists (RRT) specializing in pediatrics evaluated the efficiency of our resource utilization. Since length of mechanical ventilation directly affects the length of ICU stay, various methods of ventilator management were evaluated. We found that the estimated mean true cost per day for ventilated patients in the PICU is $1550. In response to these findings, a RRT driven ventilator management protocol was developed. We hypothesized that the implementation of a RRT driven ventilator management protocol would reduce the length of mechanical ventilation. Method. The RRT driven ventilator protocol was implemented in February, 1998. The protocol outlines specific patient and ventilator parameters; however, all parameters may be customized by physician order to meet specific patient needs. The protocol is initiated by physician order. The RRT is then responsible for all subsequent ventilator adjustments. No other written orders are required. A patient may be excluded from the protocol at any point by discretion of the attending physician. Ventilator days per patient were recorded using an electronic documentation device (Clinivision™). Data from February-July, 1997 and February-July, 1998 were compared. Results. # of patients total ventilator days ventilator days days per patient February-July 1997 210 922 4.39 February - July 1998 201 791 3.94 Conclusion. The average reduction in length of ventilator days was 0.45 days. This represents an estimated reduction in the mean true cost of $713 per patient. This is an overall estimated reduction of $143,313.
Tripp, D; Rinaldo-Gallo, S; Cheifetz, IM; Meliones, JN
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