The impact of a multidisciplinary approach on caring for ventilator-dependent patients
| Autor: | Michael P. Young, Connie B. Bohman, Valerie J. Gooder, Thomas K. French, Brent C. James, Mark H. Oltermann |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care medicine.medical_treatment law.invention law Intensive care Utah Health care Outcome Assessment Health Care medicine Humans Prospective Studies Intensive care medicine Prospective cohort study Reimbursement APACHE Aged Mechanical ventilation Patient Care Team APACHE II business.industry Health Policy Mortality rate Public Health Environmental and Occupational Health General Medicine Length of Stay Middle Aged Models Theoretical Intensive care unit Respiration Artificial Intensive Care Units Emergency medicine Chronic Disease Costs and Cost Analysis Linear Models Female business |
| Zdroj: | International journal for quality in health care : journal of the International Society for Quality in Health Care. 10(1) |
| ISSN: | 1353-4505 |
| Popis: | Objective. To determine the clinical and financial outcomes of a highly structured multidisciplinary care model for patients in an intensive care unit (ICU) who require prolonged mechanical ventilation. The structured model outcomes (protocol group) are compared with the preprotocol outcomes. Design. Descriptive study with financial analysis. Setting. A twelve-bed medical—surgical ICU in a non-teaching tertiary referral center in Ogden, Utah. Study participants. During a 54-month period, 469 consecutive intensive care patients requiring mechanical ventilation for longer than 72 hours who did not meet exclusion criteria were studied. Interventions. A multidisciplinary team was formed to coordinate the care of ventilator-dependent patients. Care was integrated by daily collaborative bedside rounds, monthly meetings, and implementation of numerous guidelines and protocols. Patients were followed from the time of ICU admission until the day of hospital discharge. Main outcome measures. Patients were assigned APACHE II scores on admission to the ICU, and were divided into eight diagnostic categories. ICU length of stay, hospital length of stay, costs, charges, reimbursement, and in-hospital mortality were measured. Results. Mortality in the preprotocol and protocol group, after adjustment for APACHE II scores, remained statistically unchanged (21—23%). After we implemented the new care model, we demonstrated significant decreases in the mean survivor's ICU length of stay (19.8 days to 14.7 days, P= 0.001), hospital length of stay (34.6 days to 25.9 days, P= 0.001), charges (US$102 500 to US$78 500, P= 0.001), and costs (US$71 900 to US$58 000, P= 0.001). Conclusions. Implementation of a structured multidisciplinary care model to care for a heterogeneous population of ventilator-dependent ICU patients was associated with significant reductions in ICU and hospital lengths of stay, charges, and costs. Mortality rates were unaffected. |
| Databáze: | OpenAIRE |
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