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Study lauds ventilator outcomes at VUH

BY: PAUL GOVERN

12/04/2009 - A study of mortality, cost and length of hospital stay of adult patients placed on mechanical ventilation points to Vanderbilt University Hospital as the nation's standout institution.

The benchmarking study was organized by University Healthsystem Consortium, an alliance of 104 academic medical centers and 220 of their affiliated hospitals. Of this group, 73 hospitals chose to participate in the ventilator study.

The study period was July through December of 2008. Patients were divided into two groups according to the amount of time spent on a ventilator, and the results were risk-adjusted, using diagnoses to weight patients according to how sick they were.

For patients on a ventilator more than 96 hours, VUH had the lowest risk-adjusted mortality, cost and length of stay. For patients on a ventilator less than 96 hours, VUH came in third, second and sixth, respectively.
VUH was the only hospital appearing in the top 10 in all six of the study's rankings.

Hospitals are prevented from divulging the identity and ranking of their fellow participants in UHC benchmarking studies, but it can freely be said that the study included the nation's most highly reputed medical centers.

“The UHC results clearly show that, through all of our efforts we achieved better outcomes than hospitals that people think of as the top of the tops in ventilator care,” said Jack Starmer, M.D., chief quality informatics officer and assistant professor of Biomedical Informatics.

“Awesome. That's fabulous,” is how the news struck one charge nurse, Mindy Mullins, R.N., of the Surgical Intensive Care Unit.

Vanderbilt's critical care nurses have for the past two years been on the front lines of an effort to enforce a set of evidence-based care guidelines for patients on ventilators.

They call it the ventilator care bundle, and these nurses greet the UHC study as one more indication that this initiative is succeeding.

“There's absolutely no question — we're achieving better management of our patients on ventilators,” said John Rice, R.N., a staff nurse in the SICU.

Adoption of the ventilator bundle “was a huge change for us. But once we got into the routine we began to understand the benefits, and to hear now about the impact we've had compared to the nation, that's pretty nice, pretty impressive,” said Jennifer Rooker, R.N., a staff nurse in the SICU.

Ventilators afford life support for patients in respiratory difficulty, assisting or replacing spontaneous breathing.

But there's a drawback — inserted through the patient's trachea, the machine's breathing tube tends to undo respiratory tract defenses and pose risk of lung infection.

Ventilator-associated pneumonia, or VAP, is a common contributing cause of death in critical care patients.

The ventilator care bundle is aimed at preventing VAP, with mouth and throat care, tighter sedation management and no delay in weaning patients off ventilation. The initiative took off once clinical information systems were adapted to allow teams to self-monitor their performance (VUMC Reporter, Feb. 13, 2009).

The VAP rate at VUH has been cut in half. Comparing recent outcomes to pre-initiative outcomes from 2007, Starmer finds that 108 additional cases of VAP were prevented during fiscal 2009, which translates as 16 fewer deaths, 1,055 fewer days in the hospital for patients and a cost reduction for the year of $4.3 million.

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