PURPOSE: Studies have demonstrated the value of intensive care unit (ICU) protocols on the duration of mechanical ventilation. These were performed primarily at teaching institutions. We utilized benchmarked severity adjusted data to demonstrate the value of protocols, a multidisciplinary team, and a part-time medical director to monitor and achieve a reduction in severity adjusted ventilator days in a community hospital open ICU.
METHODS: Sarasota Memorial Hospital's medical/surgical ICU consists of 32 beds with a clinical information system interfaced with the APACHE III critical care system. Predicted ventilator days were based on APACHE III which incorporates acute physiology, diagnosis, location of origin, and seven co-morbidities. Average number of ventilator days per patient (ANVDSP) and differences between observed and predicted days were calculated. In 2002, an intensive education effort was emphasized with physician, nursing and respiratory staff. A daily sedation wake up protocol was already in place. During the study period (2002-2005) protocols were added for the adult respiratiory distress syndrome, prevention of catheter related blood stream infections, and ventilator weaning. Coordination was through multidisciplinary rounds led by the part time medical director.
RESULTS: The ANVDSP during 2002 was 4.49. During 2005 the ANVDSP was 3.58 with a difference of 0.91 (p=.09). Figure 1 illustrates progressive improvement when observed ventilator days are compared to predicted ventilator days. During 2002 the difference between observed and predicted was +0.68. During 2005 the difference was -0.20, representing a statistically significant change of -0.88 (p<.05) Analysis showed no statistical difference for any single protocol.
CONCLUSION: Benchmarking observed to predicted ventilator days is feasible in a community hospital ICU. Multidisciplinary protocols can be implemented in a community hospital with an open admissions policy and a part time medical director. This team approach outside a teaching hospital significantly reduced observed ventilator days when compared to predicted.
CLINICAL IMPLICATIONS: Multidisciplinary directed ventilator care and weaning can be implemented in a non-teaching hospital. Utilizing benchmarked data, the effectiveness of these initiatives can be documented and demonstrated to interested parties.
DISCLOSURE: Bruce Fleegler, Consultant fee, speaker bureau, advisory committee, etc, Cerner Corporation.