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SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.
At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.
For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.
Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.
"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."
By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.
Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.
Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.
Dr. McNelis said that he had no relevant financial conflicts to disclose.
SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.
At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.
For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.
Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.
"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."
By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.
Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.
Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.
Dr. McNelis said that he had no relevant financial conflicts to disclose.
SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.
At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.
For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.
Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.
"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."
By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.
Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.
Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.
Dr. McNelis said that he had no relevant financial conflicts to disclose.
AT THE ACS NSQIP NATIONAL CONFERENCE
