Crouse Hospital approved an automatic conversion from Racemic Albuterol (Alb) 2.5mg Q4h to either Levalbuterol (Lev) 0.63 mg Q6h or Lev 1.25 mg Q8h. To further maximize Respiratory Therapist time we took the next step of automatic conversion of all Lev Q6h to Lev Q8h.
All protocol treatments delivered between 10/04 and 4/05 were recorded. Pre-conversion estimates for Alb Q4h were twice the current Lev Q8h protocol. The ratio of Lev Q6h to Q8h delivered between 1/04 and 4/04 (prior protocol) was 85%:15%. The cost for unit dose Alb was $0.22. The cost for unit dose Lev was $1.85. We used the 0.26 hour per treatment time as reported in the AARC Uniform Reporting Manual. The FTE average cost (salary/benefits) = $23.80/hr. All aerosol therapy was provided with the use of the AeroEclipse Breath Actuated Nebulizer (BAN).
The table shows the drug and labor cost for the current protocol and the estimated number of treatments, with their respective costs, for the prior protocol and pre-conversion periods. For the current protocol, the drug cost of $16,482 is lower than the prior protocol and considerably higher than the pre-conversion period. Labor costs decreased with each protocol as the number of treatments dropped. The drop in labor cost more than offset the increase drug costs in each protocol. The largest savings was seen with the current Lev Q8h protocol. The Respiratory Care Department’s total expenses for the first 3 months of this year was 8.6% under budget and 7.9% below the same time period in 2004.
Hospital-wide conversion to Lev is cost-effective when administered on both a Q6h and Q8h frequency with the maximum benefit at the Q8h frequency. Therapist availability was enhanced with fewer scheduled treatments.
The conversion to Lev allows the ability to meet our patient care demands and for the reallocation of workforce needs in an economically advantageous manner.
Pre-conversionPrior ProtocolCurrent ProtocolTreatments Alb Q4h17,818Treatments Lev Q6h9,642Treatments Lev Q8h1,6788,909Total treatments17,81811,3208,909Drug cost (dollars)$3,920$20,942$16,482Labor (hours)4,6332,9432,316Labor cost (dollars)$110,258$70,048$55,129Total cost (dollars)$114,178$90,990$71,611Savings compared with current protocol$42,567$19,380
Robert Pikarsky, None.