Prolonged post-operative ventilation times drive costs higher and have an adverse effect on patient outcomes. But even with improvements in technology and care pathways, variation in vent times still plagues service line leaders.
Though numerous studies have demonstrated that early extubation within six to eight hours of cardiothoracic surgery can be a safe way of eliminating unnecessary costs and even improving quality, this opportunity is often missed, according to a report in the Annals of Thoracic Surgery (ATS). In 2016, as few as 12 percent of cardiac surgery patients were extubated within six hours, another study in the same publication found.
The cost factor is not insignificant. Predictably, reducing ventilation times is associated with lower expenses in part because early extubation allows for shorter hospital lengths of stay (LOS) and consequently consumes less hospital resources. At Northeast Arkansas Baptist Memorial Hospital, Dr. Paul Levy spearheaded an effort to drive down cardiac surgery production costs. His team found that in 2015, only 9 percent of their patients were extubated within eight hours of their surgery, and only 35 percent of their patients had a one-day ICU length of stay. After implementing a standardized approach to cardiac anesthesia and a protocol-driven extubation process, the hospital was able to save at least $650 per case while preserving patient safety. In 12 months, 62 percent of their patients were extubated within eight hours, and 78 percent of patients had a one-day length of stay—highlighting the efficacy of establishing standard protocols in reducing unnecessary and costly practices.
Safety concerns have been quelled by studies that have found no increase in reintubation rates or 30-day mortality as a result. In addition, unnecessary ventilation increases the patient’s risk of ventilator-acquired pneumonia, prolongs the use of sedatives, and delays rehabilitation—so one could argue that it is safer. Dr. Levy’s study of elective aortic surgery found that early extubation decreased the risk of pulmonary complications such as pneumonia or reintubation.
In efforts to systematically reduce ventilation times, hospitals have found success in establishing protocol s to reduce medical errors and eliminate unnecessary practice variation. The 2016 study from the ATS found that multidisciplinary extubation protocol for cardiac surgical patients reduced ventilation time and length of stay in the ICU without compromising safety. Researchers collected data for months before and after the implementation of protocol in order to track certain measures and ensure progress. In the end, the adjusted extubation time was significantly reduced by 144 minutes, while ICU length of stay was reduced from two days to one day.
To learn more about this and other ways to increase margins and improve performance in your cardiothoracic surgery service line, download this brochure here.