Decreasing Ventilator Duration Using Lean Methodology

Abstract

Background:

There is an annual incidence of approximately 11, 000 spinal cord injuries (SCI), and 2.5 million traumatic brain injuries (TBI) in the United States per year. This group of patients is classified as diagnosis related group (DRG) 3, 4. Lean methodology was used to decrease length of stay (LOS) and ventilator length of stay (VLOS). An independent "Lean Team" (LT) was formed using a multidisciplinary approach. The team consisted of MD, NP, RT, RN navigator, PT, OT, PharmD, Speech, Case Management, and Palliative Care.

Methods:

The team focused on SCI and TBI patients admitted to the ICU. The team rounded five days a week, had bi-weekly huddle to discuss barriers, improvements, and up to date cost savings in real time. The historical cost of this group of patients from (Oct 2012-Sept 2013) was estimated at $4.5 million. After completing a fully funded 6-month trial in 2016 (72 pts) we observed a cost savings of approximately $1.5 million, by reducing VLOS by 28%, LOS by 32%, and hospital cost by 63%. Due to the success from the 6-month trial the Lean Team became a permanent service.

Results:

In 2017 the Lean Team developed and implemented standardized care for this group of patients. We developed a rounding sheet that was used daily. We rounded on these patients five days a week, and most procedures were done at bedside when clinically safe. Consistency is key to decrease cost with these complex patients. We followed these patients from time of admission to discharge and even to rehab if on campus. We worked with our adult and pediatric rehab to develop guidelines that needed to be met prior to transfer. In 2017 we observed an approx. cost savings of $1.8 million. We decreased our target VLOS from 17 d down to 11.05 d. The target LOS decreased from 23 d to 17.2 d (73 pts). In contrast there was no increase in ICU readmissions.

Conclusions:

Overall it appears that "going lean" is financially sustainable and beneficial to this patient population. Consistency is key, and initiatives that include an interprofessional team will be most successful in providing standardized, high quality care. The RT specialist was an integral part of this process and its success. We will continue to look for ways to expand and utilize the role of the respiratory therapist.