Faculty Collaboration Database

Design, testing, and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation. Am J Crit Care 1998 Jan;7(1):45-57; quiz 58-9

Date

01/16/1998

Pubmed ID

9429683

Scopus ID

2-s2.0-0031608014 (requires institutional sign-in at Scopus site)   51 Citations

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.

Author List

Burns SM, Marshall M, Burns JE, Ryan B, Wilmoth D, Carpenter R, Aloi A, Wood M, Truwit JD

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Critical Care
Critical Pathways
Evaluation Studies as Topic
Female
Humans
Length of Stay
Male
Middle Aged
Patient Care Management
Patient Care Planning
Prospective Studies
Research Design
Retrospective Studies
Time Factors
Tracheostomy
Ventilator Weaning