Shifting care of chronic ventilator-dependent patients from the intensive care unit to the nursing home.
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.
Lindsay
Mark E
ME
Lakeside Ventilator Unit, Mayo Health System, Eau Claire, Wisconsin, USA. lindsay.mark@mayo.edu
Bijwadia
Jagdeep S
JS
Schauer
Whitney W
WW
Rozich
John D
JD
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