Financial Impact of Incentive Spirometry

Abstract

Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to $240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to $136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95% confidence interval [CI], $97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be $1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable.

Incentive Spirometry for Prevention of Postoperative Pulmonary Complications After Thoracic Surgery

“…25 Although this may be true, the clinical reality is that providing more patient training and encouraging more frequent use will come at a cost, in addition to the cost of the devices, which may become difficult to justify in the context of numerous studies questioning the clinical benefit of IS. Eltorai et al 26 evaluated the financial impact of implementing IS using prospective questionnaires to evaluate the time spent by health professionals doing ISrelated activities and national survey work load data. The authors estimated that the total annual cost of implementing postoperative IS to be $1.04 billion (95% CI $949.4 million to $1.13 billion).…”

Paperometer: A Low-Cost Incentive Spirometer

“…Atelectasis also affects 90% of patients who have undergone general anesthesia, thus incentive spirometers are commonly used in patients recovering from surgery under general anesthesia or bedridden for prolonged periods of time [3][4]. Adding to the widespread need for the device, it was found that incentive spirometers are used in over 95% of US hospitals after surgery [5]. These statistics illustrate the ubiquity of respiratory conditions and the increased need for incentive spirometers.…”

“…Additionally, there are approximately 9.7 million inpatient surgeries each year in the US. These numbers indicate that the total annual cost of incentive spirometers surpasses $1 billion [5]. This value signifies the issues of overtreatment and wasted spending in the US medical industry and thus, there is an opportunity for a cheaper alternative to incentive spirometers that would lower the annual implementation costs for hospitals across the globe.…”

Human Factors and Usability of an Incentive Spirometer Patient Reminder (SpiroTimer™)

“…Incentive spirometry (IS) is commonly prescribed to reduce respiratory complications [1][2][3]. IS ( Figure 1) works by expanding alveoli through maximal inspiration to prevent atelectasis.…”