Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned
OBJECTIVETo determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes. DESIGNA multidisciplinary team was selected from five adult ICUs...
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| Veröffentlicht in: | Critical care medicine 2003-12, Vol.31 (12), p.2752-2763 |
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| creator | Burns, Suzanne M Earven, Sidenia Fisher, Charles Lewis, Rose Merrell, Paul Schubart, Jane R Truwit, Jonathon D Bleck, Thomas P |
| description | OBJECTIVETo determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes.
DESIGNA multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program.
SETTINGThe project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the followingcoronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU.
PATIENTSThe sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days.
INTERVENTIONSFull implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared.
MEASUREMENTS AND MAIN RESULTSStatistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p = .0001), ICU length of stay (median days declined from 15 to 12; p = .0008), hospital length of stay (median days declined from 22 to 20; p = .0001), and mortality rate (declined from 38% to 31%, p = .02). More than $3,000,000 cost savings were realized in the OM group.
CONCLUSIONSThis institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population. |
| doi_str_mv | 10.1097/01.CCM.0000094217.07170.75 |
| format | Article |
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DESIGNA multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program.
SETTINGThe project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the followingcoronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU.
PATIENTSThe sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days.
INTERVENTIONSFull implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared.
MEASUREMENTS AND MAIN RESULTSStatistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p = .0001), ICU length of stay (median days declined from 15 to 12; p = .0008), hospital length of stay (median days declined from 22 to 20; p = .0001), and mortality rate (declined from 38% to 31%, p = .02). More than $3,000,000 cost savings were realized in the OM group.
CONCLUSIONSThis institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000094217.07170.75</identifier><identifier>PMID: 14668611</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject><![CDATA[Academic Medical Centers ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Case Management - organization & administration ; Cost Savings ; Critical Care - organization & administration ; Critical Pathways - organization & administration ; Evidence-Based Medicine ; Female ; Hospital Mortality ; Humans ; Intensive care medicine ; Length of Stay - statistics & numerical data ; Male ; Medical sciences ; Middle Aged ; Nurse Clinicians - organization & administration ; Nurse's Role ; Nursing Evaluation Research ; Outcome and Process Assessment (Health Care) - organization & administration ; Patient Care Team - organization & administration ; Program Development ; Program Evaluation ; Prospective Studies ; Respiration, Artificial - economics ; Respiration, Artificial - mortality ; Respiration, Artificial - nursing ; Respiration, Artificial - standards ; Survival Analysis ; Time Factors ; Virginia - epidemiology]]></subject><ispartof>Critical care medicine, 2003-12, Vol.31 (12), p.2752-2763</ispartof><rights>2003 Lippincott Williams & Wilkins, Inc.</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3906-6d0dfa379468354a20906ef96f7290539176bbc9bbf20b81bf96f5a95ffef5bc3</citedby><cites>FETCH-LOGICAL-c3906-6d0dfa379468354a20906ef96f7290539176bbc9bbf20b81bf96f5a95ffef5bc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15380535$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14668611$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burns, Suzanne M</creatorcontrib><creatorcontrib>Earven, Sidenia</creatorcontrib><creatorcontrib>Fisher, Charles</creatorcontrib><creatorcontrib>Lewis, Rose</creatorcontrib><creatorcontrib>Merrell, Paul</creatorcontrib><creatorcontrib>Schubart, Jane R</creatorcontrib><creatorcontrib>Truwit, Jonathon D</creatorcontrib><creatorcontrib>Bleck, Thomas P</creatorcontrib><creatorcontrib>University of Virginia Long Term Mechanical Ventilation Team</creatorcontrib><title>Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVETo determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes.
DESIGNA multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program.
SETTINGThe project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the followingcoronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU.
PATIENTSThe sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days.
INTERVENTIONSFull implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared.
MEASUREMENTS AND MAIN RESULTSStatistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p = .0001), ICU length of stay (median days declined from 15 to 12; p = .0008), hospital length of stay (median days declined from 22 to 20; p = .0001), and mortality rate (declined from 38% to 31%, p = .02). More than $3,000,000 cost savings were realized in the OM group.
CONCLUSIONSThis institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Case Management - organization & administration</subject><subject>Cost Savings</subject><subject>Critical Care - organization & administration</subject><subject>Critical Pathways - organization & administration</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nurse Clinicians - organization & administration</subject><subject>Nurse's Role</subject><subject>Nursing Evaluation Research</subject><subject>Outcome and Process Assessment (Health Care) - organization & administration</subject><subject>Patient Care Team - organization & administration</subject><subject>Program Development</subject><subject>Program Evaluation</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - economics</subject><subject>Respiration, Artificial - mortality</subject><subject>Respiration, Artificial - nursing</subject><subject>Respiration, Artificial - standards</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Virginia - epidemiology</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFUk2P0zAQtRCILYW_gCwkuCXYcWLHe0MVHyst2gucLScZU4PjFDvZVf8NP5VJW6k-eDSeN-9p5pmQd5yVnGn1kfFyt_tesvXouuKqZIorVqrmGdnwRrCCVVo8Jxsss0LUWtyQVzn_ZozXjRIvyQ2vpWwl5xvy7248BBghznb2U6STozZSH_Ps52V9sYEe0vQr2ZHOE_UjJo9A--Cj77Fm40Cdjzb2HrNpmftphLzSjNDv7QkUjvQRBXywMwz0gEKY5Vv6EKE4gk3XtpUtQM5TzBhtijC8Ji-cDRneXOKW_Pzy-cfuW3H_8PVu9-m-6IVmspADG5wVSteyFU1tKxxdgtPSqUqzRmiuZNf1uutcxbqWd2upsbpxDlzT9WJLPpx5ccC_C-TZjD73EIKNMC3ZKNwda5F8S27PwD5NOSdw5pD8aNPRcGZWfwzjBv0xV3_MyR-jGmx-e1FZuhGGa-vFEAS8vwBsxtW5tG42X3GNaHGalag-456mMEPKf8LyBMnswYZ5f5IWVS2LCiPHC78EHin-A8o5rPI</recordid><startdate>200312</startdate><enddate>200312</enddate><creator>Burns, Suzanne M</creator><creator>Earven, Sidenia</creator><creator>Fisher, Charles</creator><creator>Lewis, Rose</creator><creator>Merrell, Paul</creator><creator>Schubart, Jane R</creator><creator>Truwit, Jonathon D</creator><creator>Bleck, Thomas P</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200312</creationdate><title>Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned</title><author>Burns, Suzanne M ; Earven, Sidenia ; Fisher, Charles ; Lewis, Rose ; Merrell, Paul ; Schubart, Jane R ; Truwit, Jonathon D ; Bleck, Thomas P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3906-6d0dfa379468354a20906ef96f7290539176bbc9bbf20b81bf96f5a95ffef5bc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Case Management - organization & administration</topic><topic>Cost Savings</topic><topic>Critical Care - organization & administration</topic><topic>Critical Pathways - organization & administration</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nurse Clinicians - organization & administration</topic><topic>Nurse's Role</topic><topic>Nursing Evaluation Research</topic><topic>Outcome and Process Assessment (Health Care) - organization & administration</topic><topic>Patient Care Team - organization & administration</topic><topic>Program Development</topic><topic>Program Evaluation</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - economics</topic><topic>Respiration, Artificial - mortality</topic><topic>Respiration, Artificial - nursing</topic><topic>Respiration, Artificial - standards</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Virginia - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burns, Suzanne M</creatorcontrib><creatorcontrib>Earven, Sidenia</creatorcontrib><creatorcontrib>Fisher, Charles</creatorcontrib><creatorcontrib>Lewis, Rose</creatorcontrib><creatorcontrib>Merrell, Paul</creatorcontrib><creatorcontrib>Schubart, Jane R</creatorcontrib><creatorcontrib>Truwit, Jonathon D</creatorcontrib><creatorcontrib>Bleck, Thomas P</creatorcontrib><creatorcontrib>University of Virginia Long Term Mechanical Ventilation Team</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burns, Suzanne M</au><au>Earven, Sidenia</au><au>Fisher, Charles</au><au>Lewis, Rose</au><au>Merrell, Paul</au><au>Schubart, Jane R</au><au>Truwit, Jonathon D</au><au>Bleck, Thomas P</au><aucorp>University of Virginia Long Term Mechanical Ventilation Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2003-12</date><risdate>2003</risdate><volume>31</volume><issue>12</issue><spage>2752</spage><epage>2763</epage><pages>2752-2763</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVETo determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes.
DESIGNA multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program.
SETTINGThe project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the followingcoronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU.
PATIENTSThe sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days.
INTERVENTIONSFull implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared.
MEASUREMENTS AND MAIN RESULTSStatistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p = .0001), ICU length of stay (median days declined from 15 to 12; p = .0008), hospital length of stay (median days declined from 22 to 20; p = .0001), and mortality rate (declined from 38% to 31%, p = .02). More than $3,000,000 cost savings were realized in the OM group.
CONCLUSIONSThis institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>14668611</pmid><doi>10.1097/01.CCM.0000094217.07170.75</doi><tpages>12</tpages></addata></record> |
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| subjects | Academic Medical Centers Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Case Management - organization & administration Cost Savings Critical Care - organization & administration Critical Pathways - organization & administration Evidence-Based Medicine Female Hospital Mortality Humans Intensive care medicine Length of Stay - statistics & numerical data Male Medical sciences Middle Aged Nurse Clinicians - organization & administration Nurse's Role Nursing Evaluation Research Outcome and Process Assessment (Health Care) - organization & administration Patient Care Team - organization & administration Program Development Program Evaluation Prospective Studies Respiration, Artificial - economics Respiration, Artificial - mortality Respiration, Artificial - nursing Respiration, Artificial - standards Survival Analysis Time Factors Virginia - epidemiology |
| title | Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned |
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