Upgrading respiratory services.Mechanical ventilation mechanical ventilation
A mode of assisted or controlled ventilation using mechanical devices that cycle automatically to generate airway pressure. incurs substantial morbidity, mortality, and costs. Because premature or delayed weaning weaning,
n the period of transition from breast feeding to eating solid foods.
the act of separating the young from the dam that it has been sucking, or receiving a milk diet provided by the dam or from artificial sources. can cause harm, weaning that is both expeditious ex·pe·di·tious
Acting or done with speed and efficiency. See Synonyms at fast1.
ex and safe is highly desirable. We assessed 312 patients/residents over a three-year period, beginning in 2003, with the baseline and treatment populations well matched on population characteristics, age distribution, sex, and primary diagnosis. Implementation of our initiative increased the wean wean (wen) to discontinue breast feeding and substitute other feeding habits.
1. To deprive permanently of breast milk and begin to nourish with other food.
2. success rate by 40.9% from 2003 to 2004, and by 65.5% from 2003 to 2005. In 2005, the number of ventilator-associated complications decreased to zero.
Background and Planning
The target population included adults with various degrees of cardiopulmonary cardiopulmonary /car·dio·pul·mo·nary/ (kahr?de-o-pool´mah-nar-e) pertaining to the heart and lungs.
Of, relating to, or involving both the heart and the lungs. diseases and conditions requiring mechanical ventilation and other levels of respiratory support. Our goals were threefold:
* To provide safe liberation or weaning from mechanical ventilation and other respiratory support for patients/residents admitted to a subacute/long-term care ventilator ventilator /ven·ti·la·tor/ (ven´ti-la-tor)
1. an apparatus for qualifying the air breathed through it.
2. a device for giving artificial respiration or aiding in pulmonary ventilation. unit from an acute care setting where prior weaning efforts had failed.
* To assist the patient/resident in achieving an optimal level of functioning.
* To set standards of practice that enhance patient/resident safety, quality of life, and quality of care.
The ventilator unit was established in 1992 to complete a natural continuum of care for ventilator-dependent patients/residents from the affiliated acute care hospital to the community, and to ensure that adequate long-term beds were available for those unable to return home immediately. Ventilator beds outside the acute care setting had been limited in this area. Individuals who could not be liberated lib·er·ate
tr.v. lib·er·at·ed, lib·er·at·ing, lib·er·ates
1. To set free, as from oppression, confinement, or foreign control.
2. Chemistry To release (a gas, for example) from combination. or weaned wean
tr.v. weaned, wean·ing, weans
1. To accustom (the young of a mammal) to take nourishment other than by suckling.
2. from the ventilator spent months in hospitals, typically with a compromised quality of life and at a tremendous expenditure of resources and finances.
Facility staff worked collaboratively with the New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of State Department of Health to develop a program that would meet the needs of patients/residents outside the hospital setting. In the early years of the facility, the facility ventilator wean rate of approximately 40% matched or exceeded success rates at large regional weaning centers, demonstrating the benefits of ventilator programs in long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. settings.
As respiratory services expanded, the number of subacute subacute /sub·acute/ (-ah-kut´) somewhat acute; between acute and chronic.
Between acute and chronic. ventilator beds was increased from 8 to the current capacity of 48, making it the largest long-term ventilator program in the state. Noninvasive ventilation was introduced and initiated throughout the facility and, beginning in early 2003, upgrades to the facility's physical plant (an emergency electrical system) and ventilator alarm system were implemented. A larger supply of bulk oxygen was obtained, and the inventory of specialty beds and augmentative aug·men·ta·tive
1. Having the ability or tendency to augment.
2. Grammar Indicating an increase in the size, force, or intensity of the meaning of an adjacent word, as up does in eat up.
n. communication devices was increased. From 2003 through 2005, mechanical ventilators were replaced systematically with sophisticated models that more effectively accommodated weaning. Staff education was provided and competencies were established on revised policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental resulting from the expansion of the program and allocation of the additional ventilator beds.
During 2003, as planning for the expansion of the unit continued, the facility's Performance Improvement Steering Committee steer·ing committee
A committee that sets agendas and schedules of business, as for a legislative body or other assemblage.
Noun (PISC PISC Public Interest Spectrum Coalition
PISC Piscataway Park (US National Park Service)
PISC Programme for the Inspection of Steel Components (United Kingdom) ) chartered the formation of a Respiratory Care Committee (RCC RCC - An extensible language. ) consisting of both leadership and clinical staff. The PISC is an interdisciplinary group that includes facility leadership and is authorized by the Board of Trustees board of trustees Politics The posse of thugs who oversee an institution's administration. See Board of directors. to provide oversight for the development, implementation, and evaluation of the Performance Improvement (PI) and Patient/Resident Safety Plan. Three representatives from the Board of Trustees are active members of this committee.
The RCC's mandate was to improve systems and processes that would facilitate optimal patient/resident outcomes, and respond to any care concerns or trends. The committee reported activities and outcomes to the Performance Improvement Committee (PIC (1) (Programmable Interrupt Controller) An Intel 8259A chip that controls interrupts. Starting with the 286-based AT, there are two PICs in a PC, providing a total of 15 usable IRQs. ) on a quarterly basis. A primary task of the group was to revise methods of data aggregation and analysis for identified respiratory measures, including patient/resident wean rates.
Current wean rates were difficult to compare with previous years' rates because the patients/residents admitted to our facility had increasingly complex medical and clinical presentations, requiring extensive nursing care, as well as equipment such as specialty tracheostomy tubes Tracheostomy tube
A tube which is inserted into an incision in the trachea (tracheostomy) to relieve upper airway obstruction.
Mentioned in: Anaphylaxis
tracheostomy tube and augmentative communication devices. This increased clinical complexity was validated by the changing Case Mix Index (CMI (Computer-Managed Instruction) Using computers to organize and manage an instructional program for students. It helps create test materials, tracks the results and monitors student progress. ), which increased from 1.7429 in 2003 to 1.7460 in 2005. A corresponding increase was noted in the CMI of the skilled nursing population. This overall increase in the CMI, coupled with the expansion plans for the respiratory programs, triggered recognition that existing systems should be revised to ensure continued quality and safety for our patients/residents.
Length of stay and individual care needs on our ventilator unit vary greatly among patients/residents, dependent on cardiopulmonary diagnoses, medical comorbidities, and candidacy to enter the facility weaning protocol. The facility's interdisciplinary ventilator team (known as the "vent" team) focuses on providing individualized in·di·vid·u·al·ize
tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es
1. To give individuality to.
2. To consider or treat individually; particularize.
3. care to achieve successful ventilator liberation and improve quality of life. While liberation from mechanical ventilation and discharge to home are the ultimate goals, each discipline works to optimize functional status and quality of life for each individual in treatment. Ventilator-dependent individuals who cannot be weaned benefit from an individualized care plan that emphasizes improved quality of life.
Other goals for each patient/resident include reducing ventilator support, decannulating the tracheostomy tube, facilitating vocal or nonvocal communication, initiating oral feeding, and increasing both independence in activities of daily living and attendance at recreational/spiritual activities. The availability of portable ventilators, with battery backup See UPS. , that can be accommodated on wheelchairs allows patients/residents the freedom to participate in those activities.
Involvement of facility leadership has been integral to the success of the program. Our leaders promote an organization-wide commitment to the provision of quality care and services, enabling a proactive approach to program development, expansion, and systems improvement, as defined in our mission statement. This philosophy creates a culture of excellence and a continuum of quality care through diverse programs that promote health, independence, and dignity.
Expenditures for capital improvements and staffing related to the expansion of the respiratory and ventilator program were budgeted by leadership and approved by the facility Board of Trustees. Examples of initiatives for which resources were allocated included:
* increases in staffing, including respiratory therapy respiratory therapy
Medical profession concerned with assisting the respiratory function of individuals who have severe lung disorders. Practices include suctioning to clear secretions from the airway, use of aerosol mists (sometimes medicated) or gases to ease breathing, , nursing, and speech pathology speech pathology
The science concerned with the diagnosis and treatment of functional and organic speech defects and disorders. Also called speech-language pathology. ;
* facility improvements, including an upgrade of emergency electrical power and of the central alarm system;
* purchase of state-of-art portable ventilators to facilitate weaning and increase participation in facility and community activities; and
* acquisition of specialty equipment, including pressure-relief mattresses and augmentative communication devices.
Oversight of the respiratory and ventilator program was assigned to the RCC, chaired by the Director of Respiratory Therapy. Members of the RCC include the Vice-President of Medical Services, a Pulmonologist pul·mo·nol·o·gist
A physician who specializes in the diagnosis and treatment of respiratory disorders. , a Primary Care Physician (PCP PCP
2. primary care physician
Pneumocystis carinii pneumonia (PCP) ), the Director of Respiratory Therapy, the Associate Director of Nursing, a Nurse Practitioner nurse practitioner
n. Abbr. NP
A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician. , Clinical Care Coordinators of the ventilator and respiratory units, the Clinical Nutrition Clinical nutrition
The use of diet and nutritional supplements as a way to enhance health prevent disease.
Mentioned in: Naturopathic Medicine Manager, the Assistant Vice-President (AVP AVP
arginine vasopressin. ) of Rehabilitation rehabilitation: see physical therapy. Services, the Director of Social Services social services
welfare services provided by local authorities or a state agency for people with particular social needs
social services npl → servicios mpl sociales , the Director of Speech Pathology, a unit Social Worker, the Director of Therapeutic Recreation, and the Vice-President of Finance.
All patients/residents are considered candidates for weaning unless excluded by pulmonary/respiratory assessment. If not excluded from the protocol, patients/residents either enter the program immediately or at a later date, as determined by their clinical condition.
The vent team assesses patients/residents upon admission, upon readmission readmission Managed care The admission of a Pt to a health care facility for a condition–eg, stroke, MI, GI bleeding, hip fracture, cancer surgery, shortly after discharge. See nth admission. Cf Admission, Discharge. , and at additional scheduled intervals. The members of the vent team, which meets weekly in a clinical rounds format, are the PCP, Pulmonologist, Director of Respiratory Therapy or designee des·ig·nee
A person who has been designated. , Nursing Clinical Care Coordinators, AVP of Rehabilitation, Director of Speech-Language Pathology, Chief Clinical Dietitian dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease.
di·e·ti·tian or di·e·ti·cian
A person specializing in dietetics. , Social Worker, Therapeutic Recreation Leader, and consulting Psychologist (ad hoc For this purpose. Meaning "to this" in Latin, it refers to dealing with special situations as they occur rather than functions that are repeated on a regular basis. See ad hoc query and ad hoc mode. ). While staff respiratory therapists drive the weaning process, the interdisciplinary team interdisciplinary team,
n a group that consists of specialists from several fields combining skills and resources to present guidance and information. develops a comprehensive care plan for each individual, with a focus on both quality of care and quality of life.
Family members are considered vital members of the team and participate in the care-planning process by providing information about patient/resident goals, care, and treatment preferences, as well as about advance directives Advance Directive
A document expressing a person's wishes about critical care when he or she is unable to decide for him or herself. However, it does not authorize anyone to act on a person's behalf or make decisions the way a power of attorney would. and end-of-life decisions.
Significant staff training and education activities were required for expansion of this program. Standards of care Standards of care are medical or psychological treatment guidelines, and can be general or specific. They specify appropriate treatment protocols based on scientific evidence, and collaboration between medical and/or psychological professionals involved in the treatment of a given and safety were the primary focus, with topics including disease states leading to respiratory failure Respiratory Failure Definition
Respiratory failure is nearly any condition that affects breathing function or the lungs themselves and can result in failure of the lungs to function properly. , concepts of mechanical ventilation and alarm response, assessment techniques, noninvasive monitoring tools, potential complications associated with long-term ventilator dependence, and managing respiratory emergencies. Use of new equipment and revised policies and procedures were also covered.
Performance Measurement and Data Analysis
Our data analysis compares two populations: the Baseline group comprising data from the year 2003, and the Treatment group after the key performance improvement initiatives were implemented in 2004 and 2005. The analysis includes 312 cases measured over three years. The data were extracted by the Director of Respiratory Therapy from patient/resident charts as recorded and were subsequently reviewed for accuracy.
Analysis was done on purely objective measures collected and reported quarterly, using mean numbers on the Detailed Ventilator Data Sheet (table 1), compared in aggregate and in isolation with the base-year outcomes. Data elements were recorded on the Ventilator Dependent Patient/Resident Data Form.
Risk adjustment was performed using population characteristics, age distribution, and sex to determine if the similarities between cohorts were statistically significant. Further evaluation was done using the SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 13.0 package, running a regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. of weaned versus non-weaned patients/residents based on primary diagnosis to determine its relation to probability of weaning. The analysis concluded that the population characteristics, age distribution, sex, and primary diagnosis of the Baseline and Treatment populations were well matched.
Primary endpoints were the wean success rate for those residents entered into and remaining in the wean protocol compared with the Baseline population. Any reduction in the number of ventilator days was also of interest, as it represented reduced costs and increased patient/resident safety and quality of life.
Following implementation, the wean success rate for the Treatment population increased by 40.9% in 2004, and by 65.5% in 2005, compared with the Baseline population. The average number of days on the ventilator for weaned patients decreased from 121.6 in the Baseline population to a low of 108.8 in the Treatment population, and the average number of days to wean a patient/resident from date of entry into the protocol declined from 62.2 in the Baseline population to a low of 56.7 for the Treatment population. Also, the percentage of patients/residents in the wean protocol increased 18% from the Baseline population (table 2).
On a quarterly basis, the Director of Respiratory Therapy presents outcome data (figures 1 and 2) and subsequent improvement activities to the RCC, which reports these results to the PISC and PIC. The Board of Trustees receives copies of all PISC and PIC minutes and an annual evaluation of the PI program. Department directors disseminate findings of performance improvement activities and root cause analysis (RCA See RCA connector and video/TV history. ) findings to their respective departments. Information is also shared during informal venues, such as clinical "vent" rounds. This sharing of vent outcomes has helped to create a data-conscious, data-driven culture on the unit.
Both the expansion of the respiratory care services and the refinement of the weaning protocol were implemented using the "organizational cycle for performance improvement" (plan, do, check, act). Specific improvements included:
* Staffing revisions, including increasing the ratio of respiratory therapists to patients/residents (with the addition of a lead respiratory therapist position), reallocation Noun 1. reallocation - a share that has been allocated again
allocation, allotment - a share set aside for a specific purpose
2. reallocation of nursing (RN) support, and increased speech pathology hours beginning in January 2003. These increased hours of direct staff care facilitated identification of appropriate candidates for attempts at ventilator liberation, as well as continued assessment and monitoring of patients/residents while in the weaning protocol.
* Ongoing staff education and competency training on all revised policies, procedures, and programs, integrating all training into facility orientation and annual mandatory training. Certain aspects are included in annual competency evaluations In psychometrics, applied linguistics and education, competency evaluation is a means for teachers to determine the ability of their students in other ways besides the standardized test.
Usually this includes portfolio assessment. to maintain established standards of practice.
* Revised weaning protocols (in 2004), shifting from an acute care model to one that was more flexible and allowed the respiratory therapist to change weaning modes based on clinical parameters and patient/resident need. This results in a more flexible, individualized approach that accommodates patient/resident tolerance of the changes in respiratory support that occur during weaning.
* Equipment upgrades (beginning in 2003), including systematic replacement of ventilators and clinical alarms with state-of-the-art models that more effectively accommodate weaning and improved safety.
* Formation of the Respiratory Care Committee in November 2003.
* Standardized standardized
pertaining to data that have been submitted to standardization procedures.
standardized morbidity rate
see morbidity rate.
standardized mortality rate
see mortality rate. respiratory order forms to reduce the chance of transcription errors A transcription error is a specific type of data entry error that is commonly made by human operators or by optical character recognition programs (OCR). Human transcription errors are commonly the result of typographical mistakes, putting fingers in the wrong place during touch in handwritten hand·write
tr.v. hand·wrote , hand·writ·ten , hand·writ·ing, hand·writes
To write by hand.
[Back-formation from handwritten.]
Adj. 1. information. Including orders for the weaning process, these forms were developed, piloted, revised, and finally implemented between January 2004 and July 2004.
* Revised respiratory data-collection efforts to more accurately measure wean rates and unplanned tracheostomy tube decannulations, and respond to any trends or concerns. In 2004, data collection was expanded to include length of time from entry into the protocol to its successful completion. In 2005, data collection was further expanded to identify those individuals whose weaning was deferred or discontinued dis·con·tin·ue
v. dis·con·tin·ued, dis·con·tin·u·ing, dis·con·tin·ues
1. To stop doing or providing (something); end or abandon: because of medical instability and/or hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun)
1. the placing of a patient in a hospital for treatment.
2. the term of confinement in a hospital. . Patients/residents were also identified as having no wean potential because of medical diagnosis or placement into the palliative care palliative care (paˑ·lē·ā·tiv kerˑ),
n an approach to health care that is concerned primarily with attending to physical and emotional comfort rather program. These two groups of patients/residents were removed from the denominator denominator
the bottom line of a fraction; the base population on which population rates such as birth and death rates are calculated.
denominator when calculating wean data, thereby obtaining a more accurate measure.
* Streamlining of the clinical rounds format for greater efficiency and effectiveness. Members of the vent team meet weekly and collaborate to identify patients/residents ready to enter the weaning protocol. For example, the team monitors nutritional status nutritional status,
n the assessment of the state of nourishment of a patient or subject. (through lab values), wound healing wound healing Physiology The repair of a wound Steps Inflammation, repair and closure, remodeling, final healing; repair of incisions may be either simple–'clean' wounds with little loss of tissue heal by 'primary intention', or 'dirty' wounds heal by , and the ability to participate in restorative re·stor·a·tive
1. Of or relating to restoration.
2. Tending or having the power to restore.
A medicine or other agent that helps to restore health, strength, or consciousness. rehabilitation as measures of readiness to begin attempts at ventilator liberation.
* Creation of a Supplemental Data Form to be completed by the transferring facility, ensuring that patients/residents have comprehensive and accurate clinical information available upon admission. The form identifies high-risk patients, clinical concerns, or special needs (e.g., specialty tracheotomy tubes tracheotomy tube
A curved tube used to keep the stoma unobstructed after tracheotomy. or modified oral diets for swallowing problems). This form was piloted in December 2004 and implemented in March 2005.
* Completion in February 2005 of a RCA for patients/residents with specialty tracheostomy tubes. The Supplemental Data Form and the facility transfer form were modified to highlight information that, if not communicated to the receiving caregiver, would place the patient/resident at risk.
* A standardized respiratory assessment form with input from the respiratory staff. The form is used upon admission or readmission to the facility, at scheduled periodic tracheostomy tube changes, after an unplanned decannulation, and during weaning attempts. The form was created in early 2005 and implemented in May of that year.
* Revised weaning or ventilator liberation policy to standardize stan·dard·ize
1. To cause to conform to a standard.
2. To evaluate by comparing with a standard. monitoring criteria for patients/residents in different phases of the weaning process. Revisions include ongoing respiratory therapy assessment during the liberation phase and transfer of the patient/resident to a respiratory step-down unit at completion of the weaning protocol. This policy was revised in December 2005 and implemented in January 2006.
After collecting, monitoring, and analyzing approximately three years of data, team members recognized the potential value of a predictive weaning scale that would identify patients/residents who could not initially be entered into the weaning protocol. Initial criteria for entry into the weaning protocol were limited to respiratory and clinical parameters that reflected cardiopulmonary and hemodynamic he·mo·dy·nam·ics
n. (used with a sing. verb)
The study of the forces involved in the circulation of blood.
he stability. Individuals who did not meet criteria would benefit from other programmatic pro·gram·mat·ic
1. Of, relating to, or having a program.
2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.
3. aspects of the unit and would be reassessed for weaning potential at a later time, allowing for certain key clinical indicators clinical indicator Patient care An objective measure of the clinical management and outcome of Pt care to improve.
As the process evolved, other measures were identified as potentially having predictive value pre·dic·tive value
The likelihood that a positive test result indicates disease or that a negative test result excludes disease.
a measure used by clinicians to interpret diagnostic test results. for the success of weaning efforts. The facility Minimum Data Set (MDS MDS,
n See temporomandibular pain-dysfunction syndrome.
MDS 1 Maternal deprivation syndrome, see there 2 Myelodysplastic syndrome, see there ) report was considered a source of comprehensive clinical information, with individualized assessments generating quality indicator reports that offered data on measures affecting care outcomes. Examples of these measures include the ability to understand and be understood, pressure ulcers Pressure ulcer
Also known as a decubitus ulcer, pressure ulcers are open wounds that form whenever prolonged pressure is applied to skin covering bony outcrops of the body. Patients who are bedridden are at risk of developing pressure ulcers. , infections, pain, and presence of indwelling catheters indwelling catheter Any catheter, usually understood to be for the urinary bladder–eg, a 'Foley' left in place for a prolonged period of time . These standardized clinical parameters can be incorporated into a predictive weaning tool, ultimately producing a Wean Assessment Score. Currently the RCC is developing a Wean Assessment Scale to predict candidacy for entry into and potential success within the weaning protocol. This scale is being piloted on the ventilator unit.
The ventilator program performance improvement initiative had to overcome several obstacles, including:
* The acuity acuity /acu·i·ty/ (ah-ku´i-te) clarity or clearness, especially of vision.
Sharpness, clearness, and distinctness of perception or vision. of the ventilator population and the overall patient/resident population significantly increasing from baseline.
* A significant need for staff education to ensure success and patient/resident safety.
* A need for additional resources, such as facility and equipment upgrades. Trustee and executive-level support facilitated these upgrades.
* A need for widespread revision of policies, procedures, and tools.
* Unrealistic family expectations, patient/resident anxiety, and need for support, and occasional communication barriers and cultural issues.
In addition to the increases in weaning rates by 40.9% in 2004 and by 65.5% in 2005, the number of days to wean from entry into protocol and the average number of days on vents decreased initially from baseline. Moreover, there was a positive impact on costs: In comparison with acute care ventilator care, the cost of long-term ventilator care is significantly lower ($2,200/patient/day versus $821/patient/day). When calculating implied savings, weaning patients/residents in the long-term care setting saves approximately $489/patient/day or, compared with baseline, an aggregate of $1,258,773 in 2004 and $2,188,164 in 2005 (table 3).
A successful weaning protocol attempts to improve the overall quality of life and health status for all ventilator-dependent patients/residents. Our results show that improvements in clinical care can be realized even when weaning cannot be immediately achieved.
The Silvercrest Center for Nursing and Rehabilitation is a state-of-the-art Center of Excellence that has a widespread reputation for combining the best in clinical care with the best in nursing care, and for the broadest menu of services to ease a patient's path to recovery--from hospital to home. It features New York State's largest and oldest ventilator-dependent program. The Silvercrest Center is a member of the New York-Presbyterian Healthcare System and an affiliate of the Weill Medical College of Cornell University Cornell University, mainly at Ithaca, N.Y.; with land-grant, state, and private support; coeducational; chartered 1865, opened 1868. It was named for Ezra Cornell, who donated $500,000 and a tract of land. With the help of state senator Andrew D. , with immediate access to the full range of specialists, advanced technology and other resources the system offers. To send your comments to the editors, e-mail 1optima op·ti·ma
A plural of optimum. email@example.com.
Janet Berding, Director of Respiratory Therapy
Karen Dikeman, Assistant Vice-President of Rehabilitation Services
Robert Fleming Robert Fleming is the name of:
Denise Lawson, Director of Performance Improvement
Lloyd Torres, Special Projects
by the staff of The Silvercrest Center for Nursing and Rehabilitation, Briarwood bri·ar·wood
Wood from the root of the briar.
Noun 1. briarwood - wood from the hard woody root of the briar Erica arborea; used to make tobacco pipes
brier-wood, brierwood , New York
Table 1. Detailed Ventilator Data Sheet. 1Q-03 2Q-03 3Q-03 4Q-03 Total vent patients 57 53 65 66** Total vent days 3345 3490 3922 4243 Total new vents 17 12 23 19 Male 7 4 10 11 Female 10 8 13 8 Age range 39-86 25-89 55-91 20-97 Avg. age 67 71 77 74 Total readmits and/or previously 29 20 77* 25 known Total previously weaned 0 0 2 2 Total # palliative, no wean potential, weaning deferred Total # wean potential Total new pts entered into 18 10 17 13 weaning protocol Male 9 3 6 5 Female 9 7 11 8 Total # in weaning protocol 30 28 36 43 Total % in weaning protocol 53% 53% 55% 65% 1Q-03 2Q-03 3Q-03 4Q-03 Total # of pts with weaning 2 5 4 5 held, D/C'd, or expired while in protocol Total % in weaning protocol/ total # wean potential Total # remaining in protocol 28 23 32 38 Total # patients weaned 10 4 2 10 Male 5 2 1 7 Female 5 2 1 3 Average # days to wean from entry into protocol Average # days to wean from date of admission % weaned/total # remaining 35.7% 17.4% 6.3% 26.3% % weaned/total # in protocol 33.3% 14.3% 5.6% 23.3% % weaned/total # vents 18.0% 7.5% 3.1% 15.2% Vent-associated complications 1 1 0 0 1Q-04 2Q-04 3Q-04 4Q-04 Total vent patients 73 67 67 73 Total vent days 4093 4135 3694 3945 Total new vents 23 19 20 26 Male 9 6 10 10 Female 14 13 10 16 Age range 20-98 25-95 49-91 45-90 Avg. age 75 76 76 74 Total readmits and/or previously 30 30 27 31 known Total previously weaned 3 1 1 1 Total # palliative, no wean potential, weaning deferred Total # wean potential Total new pts entered into 15 19 29 19 weaning protocol Male 8 5 9 11 Female 7 14 20 8 Total # in weaning protocol 43 41 52 44 Total % in weaning protocol 59% 61% 78% 60% 1Q-04 2Q-04 3Q-04 4Q-04 Total # of pts with weaning 9 18 19 12 held, D/C'd, or expired while in protocol Total % in weaning protocol/ total # wean potential Total # remaining in protocol 34 23 33 32 Total # patients weaned 12 6 8 11 Male 5 2 1 7 Female 7 4 7 4 Average # days to wean from 76 51 36.5 50 entry into protocol Average # days to wean from date 93.2 82.5 108 125 of admission % weaned/total # remaining 35.0% 26.0% 24.2% 34.0% % weaned/total # in protocol 28.0% 14.6% 15.4% 25.0% % weaned/total # vents 16.4% 9.5% 12.0% 15.0% Vent-associated complications 1 1 0 2 1Q-05 2Q-05 3Q-05 4Q-05 Total vent patients 81 67 80 61 Total vent days 3932 4217 3886 4382 Total new vents 27 18 29 7 Male 14 6 13 2 Female 13 12 16 5 Age range 18-102 47-92 35-98 24-83 Avg. age 73 75 76 66 Total readmits and/or previously 24 27 30 35 known Total previously weaned 2 3 8 4 Total # palliative, no wean 19 20 19 17 potential, weaning deferred Total # wean potential 62 47 59 44 Total new pts entered into 31 27 30 27 weaning protocol Male 12 6 14 10 Female 19 21 16 17 Total # in weaning protocol 43 40 49 41 Total % in weaning protocol 53% 60% 61% 67% 1Q-05 2Q-05 3Q-05 4Q-05 Total # of pts with weaning 19 11 23 5 held, D/C'd, or expired while in protocol Total % in weaning protocol/ 69% 85% 61% 67% total # wean potential Total # remaining in protocol 24 29 26 36 Total # patients weaned 11 10 12 8 Male 7 2 4 3 Female 4 8 8 5 Average # days to wean from 60 86.7 54.6 67.6*** entry into protocol Average # days to wean from date 84 127 109 102.8**** of admission % weaned/total # remaining 45.8% 34.4% 46.0% 23.0% % weaned/total # in protocol 26.0% 25.0% 25.0% 20.0% % weaned/total # vents 13.6% 14.9% 15.0% 13.1% Vent-associated complications 0 0 0 0 * 43 hospital admissions and 39 readmits were caused by the August 2003 blackout ** 4th quarter 2003 data include 5S *** # days to wean from entry into protocol (range = 46-301) **** # days to wean from date of admission (range = 46-1838) excludes 1 resident admitted 11/8/2000--weaned 12/21/2005 Ventilator Dependent Program -- Weaned Patients 2003-2005 Total # patients Total # patients Total # Total # vent in weaning weaning held, remaining in patients protocol D/C, expired protocol 2003 241 137 16 121 2004 280 180 58 122 2005 289 212 58 115 Total # patients # vent associated weaned complications 2003 26 2 2004 37 4 2005 41 0 Figure 1. Weaning Outcomes -- 2003-2005 Total % in % Weaned total % Weaned total % Weaned remaing weaning protocol # of vents # in protocol in protocol 2003 56.8% 10.8% 19.0% 21.5% 2004 64.3% 13.2% 20.6% 30.3% 2005 73.4% 14.2% 19.3% 35.7% Figure 2. Table 2. Ventilator Outcomes 2003 2004 2005 Total # vent patients (1) 241 280 289 Age range 25-97 20-98 18-102 Average age 72.25 75.25 72.5 Total vent days 15,000 15,867 16,417 Average # of days from admission to 121.6 108.0 163.5 wean Average # of days from protocol entry 62.2 57.6 76.1 to wean # palliative, no wean potential (2) -- -- 75 # new patients entered wean protocol 58 82 115 Total # patients in weaning protocol 137 180 212 Total % in weaning protocol 56.8% 64.3% 73.4% Total # patients weaning held, D/C 16 58 58 Total # remaining in protocol 121 122 115 Total # patients weaned 26 37 41 % weaned total # of vents 10.8% 13.2% 14.2% % weaned total # in protocol 19.0% 20.6% 19.3% % weaned remaining in protocol 21.5% 30.3% 35.7% # vent-associated complications 2 4 0 (1) Total of the four quarters (2) Measure started in 2005 Table 3. Ventilator Cost Comparison 2003 2004 2005 Total # patients weaned 26 37 41 ICU costs (vent days x $33,000,000 $34,907,400 $36,117,400 rate)* Vent costs (vent days x $12,615,000 $9,876,890 $10,219,254 rate)* SNF cost (vent days x $4,980,000 $5,394,621 $5,581,616 rate)* LTC vent savings vs. ICU $20,385,000 $25,030,510 $25,898,146 SNF savings vs. LTC vent $7,635,000 $4,482,269 $4,637,638 Average vent days-- 59.35 50.40 87.46 average wean days Wean savings vs. ICU $2,882,324 $2,534,263 $4,873,374 Wean savings vs. LTC $785,387 $949,183 $1,825,274 vent *Rates: ICU = $2200 per patient per day. LTC vent = $821 per patient per day DNF = $332 per patient per day