title: Shifting care of chronic ventilator-dependent patients from the intensive care unit to the nursing home.
abstract: BACKGROUND
  Among the most resource intensive and challenging of medical needs is the treatment of patients requiring long-term or chronic mechanical ventilation. Expenditures are significant, and definitions of "successful weaning," are often inconsistent. A weaning program was initiated for patients referred to a stand-alone nursing home ventilator unit.
  
  
  METHODS
  Weaning entailed standardized weaning protocols, enhanced socialization, a multidisciplinary approach to care, empowerment of staff to initiate weaning, and aggressive utilization of noninvasive positive pressure ventilation (NPPV) in selected patients.
  
  
  RESULTS
  Sixty-eight (67%) of 102 patients were successfully weaned during a six-year period. NPPV facilitated successful weaning in 27 (26%) of 102 patients. Of the 28 chronic ventilator-dependent patients admitted with a neuromuscular etiology for respiratory failure, NPPV was utilized in 73% (8/11) of the successfully weaned patients. Total variable costs per ventilator per patient per day for the years 1998-2000 were $319.79, $302.75, and $297.59. Six-year cost savings for referring hospitals were estimated at $18.5 million.
  
  
  CONCLUSIONS
  Incentives were aligned between the hospital, nursing home, and physicians to develop a financially stable model. Developing an off-site nursing home ventilator unit resulted in significant cost savings to the referring hospitals and positively affected patient flow.
authors.affiliation: Lakeside Ventilator Unit, Mayo Health System, Eau Claire, Wisconsin, USA. lindsay.mark@mayo.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Lindsay
authors.forename: Jagdeep S
authors.initials: JS
authors.lastname: Bijwadia
authors.forename: Whitney W
authors.initials: WW
authors.lastname: Schauer
authors.forename: John D
authors.initials: JD
authors.lastname: Rozich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team; D010360:Patient Transfer / Q000191:economics; D011175:Positive-Pressure Respiration; D011785:Quality Assurance, Health Care; D015300:Ventilator Weaning / Q000191:economics / Q000379:methods; D014922:Wisconsin