Design, testing, and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation

Abstract

BACKGROUND: Outcomes management that uses critical pathways may decrease costs while improving outcomes for patients who require prolonged mechanical ventilation. OBJECTIVE: To study the efficacy of an outcomes-managed approach to weaning patients from prolonged (more than 3 days) mechanical ventilation. METHODS: A method of multidisciplinary care delivery was designed that included an outcomes manager, a care pathway for patients receiving mechanical ventilation, and weaning protocols. Data collection consisted of three parts: a retrospective review of 124 patients who required prolonged ventilation during a 1-year period before implementation of the care model, a 6-month prospective study in which 91 patients were alternately assigned by month to an outcomes-managed approach or a non-outcomes-managed approach, and a 6-month prospective study of 90 patients in which an outcomes-managed approach without alternate-month assignment was used. RESULTS: Outcomes management had no significant effect on total duration of mechanical ventilation or length of stay in the hospital, days of mechanical ventilation without tracheostomy, days of mechanical ventilation with tracheostomy, or outcome (weaned, withdrawal from mechanical ventilation, death, or transfer without weaning). However, duration of mechanical ventilation was 1.3 days shorter, length of stay in the hospital was 2.1 days shorter, and the cost per case was $ 3341 less for patients in the outcomes-managed group than for patients in the non-outcomes-managed group. CONCLUSION: Outcomes-managed care did not have a significant effect on duration of ventilation, length of stay in the hospital, or outcome in patients receiving long-term mechanical ventilation.

Evaluation of a nurse consultant's clinical activities and the search for patient outcomes in critical care

“…Emphasis on ensuring that care was given in accordance with agreed standards and hospital policies has some similarities with the United States (US) model of ‘managed‐care’ where an advanced nurse practitioner is employed within a clinical team to maintain quality of care and control costs (Satinsky 2000). Outcomes‐managed care has resulted in improved clinical and financial outcomes when acute care nurse practitioners manage patients (Burns et al. 1998, Russell et al.…”

Ventilatory weaning: a case study of protracted weaning

“…Jenny and Logan (1994), who originally defined DVWR, undertook qualitative work regarding the weaning experience (Logan and Jenny, 1997), establishing that while patients became engaged in the process of weaning, it was a stressful experience requiring active participation. Advice and evidence around nurse‐led weaning, where nurses initiate weaning processes, can be conflicting and controversial (Kollef et al , 1997; Burns et al , 1998; Crocker, 2002; Blackwood et al , 2004; Gelsthorpe and Crocker, 2004). Rose and Nelson (2006) undertook a literature review into the evidence for nurse‐led weaning and concluded that there was strong evidence for the safe use of nurse‐led (and other allied health professional) ventilatory weaning.…”

Large Scale Implementation of a Respiratory Therapist– driven Protocol for Ventilator Weaning

“…Although other investigators have reported initiation of various weaning algorithms (15)(16)(17), little published information about the details of compliance with such protocols exists. The first step of our approach involved the RCPs' morning assessment using the DS of weaning parameters.…”