Shifting care of chronic ventilator-dependent patients from the intensive care unit to the nursing home

Jt Comm J Qual Saf. 2004 May;30(5):257-65. doi: 10.1016/s1549-3741(04)30028-6.

Abstract

Background: Among the most resource intensive and challenging of medical needs is the treatment of patients requiring long-term or chronic mechanical ventilation. Expenditures are significant, and definitions of "successful weaning," are often inconsistent. A weaning program was initiated for patients referred to a stand-alone nursing home ventilator unit.

Methods: Weaning entailed standardized weaning protocols, enhanced socialization, a multidisciplinary approach to care, empowerment of staff to initiate weaning, and aggressive utilization of noninvasive positive pressure ventilation (NPPV) in selected patients.

Results: Sixty-eight (67%) of 102 patients were successfully weaned during a six-year period. NPPV facilitated successful weaning in 27 (26%) of 102 patients. Of the 28 chronic ventilator-dependent patients admitted with a neuromuscular etiology for respiratory failure, NPPV was utilized in 73% (8/11) of the successfully weaned patients. Total variable costs per ventilator per patient per day for the years 1998-2000 were $319.79, $302.75, and $297.59. Six-year cost savings for referring hospitals were estimated at $18.5 million.

Discussion: Incentives were aligned between the hospital, nursing home, and physicians to develop a financially stable model. Developing an off-site nursing home ventilator unit resulted in significant cost savings to the referring hospitals and positively affected patient flow.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intensive Care Units* / economics
  • Intensive Care Units* / statistics & numerical data
  • Middle Aged
  • Nursing Homes* / economics
  • Nursing Homes* / statistics & numerical data
  • Patient Care Team
  • Patient Transfer* / economics
  • Positive-Pressure Respiration
  • Quality Assurance, Health Care*
  • Ventilator Weaning* / economics
  • Ventilator Weaning* / methods
  • Wisconsin