Respiratory Care |

Mayo Clinic Program for Liberation of Patients With Prolonged Mechanical Ventilation in a Community Setting FREE TO VIEW

Jeff Rabatin; Jeff Appelquist; Kayla Dascher; Vicki Loeslie; Dennis Spano
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Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):898A. doi:10.1378/chest.1985415
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients requiring prolonged mechanical ventilation following an acute hospitalization typically require continued care in a long-term care hospitals (LTCH) or Skilled Nursing Facilities (SNF). Most LTCH are located in urban areas and most SNF are not staffed to liberate patients. Mayo Clinic Rochester (MCR) acute care hospital (ACH) partnered with Mayo Clinic Health System in Lake City (Critical Access Hospital (CAH) and SNF) to create a high quality post acute pathway care for such patients in a community setting. The Mayo Clinic Health System (MCHS) in Lake City multidisciplinary team consists of providers (MD, CNP), Nurses, Nursing Assistants, Respiratory therapists, Physical, Occupational and Speech therapists, Dietitians, Social Workers. Ongoing training and education occur with annual competencies. Bedside rounds include assessment and standardized process to liberate appropriate patients in both CAH and SNF from mechanical ventilation.

METHODS: Description statistics are used to describe the results.

RESULTS: From July 2009 - January 31, 2013, a total of 42 patients who required prolonged mechanical ventilation were admitted to Mayo Clinic Health System in Lake City. There were 30 admissions to the CAH and 12 to the SNF. The median length of stay (LOS) and interquartile range (IQR) of patients in the CAH = 22 (9 - 35) days and in the SNF = 32.5 (13 - 165) days. The median number of ventilator days and IQR of patients in the CAH = 13 (5-28) and SNF = 30 (11-153). The discharge disposition of patients from the CAH was: 30% home (9/30); 17% deceased (5/30); 13% readmitted to ACH (4/30); 3% currently admitted (1/30); 20% transferred to Lake City SNF (6/30); 17% transferred to a non-Lake City SNF (5/30). The discharge disposition of patients from the SNF was: 25% home (3/12); 25% deceased (3/12); 67% currently admitted (8/12). The total number of patients liberated from the ventilator: CAH 11/25 (5 N/A) = 44%, and SNF Liberation: 3/9 (9 N/A)= 33%.

CONCLUSIONS: The MCHS in Lake City offers a high quality post-acute care pathway for patients requiring prolonged mechanical ventilation in a community setting.

CLINICAL IMPLICATIONS: Patients requiring prolonged mechanical ventilation at MCR have additional options for post-acute care.

DISCLOSURE: The following authors have nothing to disclose: Jeff Rabatin, Jeff Appelquist, Kayla Dascher, Vicki Loeslie, Dennis Spano

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