Abstract
Background:
The Virtual Critical Care Respiratory program collaborated with a fourteen bed ICU, Atrium Health Union, to establish a target time for the daily Spontaneous Awakening and Breathing Trials (SAT/SBT). Once the targeted time was in place, the Virtual Respiratory Therapists (VRTs) would implement the idea of SBT re-trials on patients who meet criteria to decrease VLOS to a higher degree. Re-trials are defined as a second trial for those meeting the criteria per protocol, who failed the initial daily trial, or did not meet criteria previously but have been managed up. This program can positively impact overall VLOS by encouraging re-trials resulting in earlier extubations and decreased ventilator days.
Methods:
IRB approval was received, and the project was deemed quality improvement. A cohort study was performed. All vented subjects during quarter 1 2019 at a comparable facility, Atrium Health Cleveland, were identified. Encounters were analyzed for re-trial opportunities in addition to the daily SBT. The VCC teams collaborated with bedside teams to set a specific time for daily SBTs at AH Union. VRTs assessed remaining vented patients after the daily trails to make suggestions for optimization and re-trials.
Results:
330 encounters were analyzed at AH Union during quarter 1. 303 encounters remained vented after the daily SBT. 48 of 57 re-trials were scheduled and completed. 32 of 48 re-trials were done and passed resulting in 31 encounters liberated from the vent with the VRT initiative. The total vent days, average vent days, and vent days/patient days (%) were compared between AH Cleveland, with no VRT intervention, and AH Union, with VRT intervention. The total vent days at AH Cleveland for 2019 quarter 1 were 300.5, with the average being 4.4 days. The total vent days at AH Union for 2019 quarter 1 were 326.2 days, average 3.8 days yielding a vent days/patient days 44%. In comparison to AH Union’s 2018 quarter 1 total vent days of 370.1, average of 4.4 days yielding a vent days/patient days 49.3%. A significant reduction in ventilator days was identified with the VRT re-trial initiative.
Conclusions:
Virtual Respiratory Therapists implemented the process of ventilator liberation re-trails that positively affected VLOS as the Power BI, Atrium Health’s system data base, vent days for January 2018 were 3.75 and decreased for January 2019 to 3.31 days for AH Union. AH Cleveland’s VLOS for Jan 2019 was 4.39 days without any VRT interventions.
Atrium Health Union Ventilator Length of Stay O/E trends from before and after VRT SBT re-trial iniative.
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