A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.
BACKGROUND
The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes.


METHODS
A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared.


RESULTS
During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events.


CONCLUSIONS
We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes.
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Cavarocchi
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Wallace
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Hong
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Tropea
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Byrne
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Pitcher
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA hitoshi.hirose@jefferson.edu.
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Hirose
D004502:Education, Medical, Continuing / Q000191:economics* / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000193:education*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male
ECMO; ICU; cost; patient safety