Complementing Hospital Information Systems

Transcription

1 About Mediware + Rehabilitation and Respiratory Care Division years in business + Specialists Knowledge & Experience + Acute, IRF, SNF, LTAC, Home + Outpatient Rehab + Respiratory + Solution MediLinks + Compliance + Outcomes + Revenue + Efficiency Chandler, AZ headquarters

2 Complementing Hospital Information Systems Pre-built HL7 Interfaces ADT In Orders In/Out Results In/Out Billing Out Narrative In/Out Scheduling In/Out MEDITECH Experience with all HIS Improved Workflow

3 A Few of Our Clients

4 Today s Featured Speaker + + Michael Hewitt, RRT, ACCS, NPS, RCP, FAARC, FCCM + Clinical Manager, Respiratory Care Services, Rhode Island Hospital & Hasbro Children s Hospital

5 Michael J Hewitt, RRT, ACCS, NPS, RCP, FAARC, FCCM Michael Clinical J Hewitt, Manager, RRT, Respiratory ACCS, ACCS, NPS, NPS, RCP, RCP, Care FAARC, FAARC, Services FCCM FCCM Clinical Manager, Respiratory Care Care Services Services Rhode Island Hospital Hasbro Children s Hospital Rhode Island Hospital && Hasbro Children s Hospital Hospital Principal Teaching Hospital For The Alpert School of Medicine of Brown University Principal Teaching Hospital For The Alpert School of Medicine of of Brown of Brown University University Providence, Island Rhode Rhode Island Island Chair, Respiratory Section Chair, Respiratory Section Society of of Critical Care Medicine Society of Critical Care Medicine

6 Conflict of Interest Disclosures Type of Potential Conflict Grant/Research Support Consultant Speakers Bureaus Financial support Other Details of Potential Conflict Monaghan Medical, Hollister, Inc

7 Sobering Facts: 54% of ventilated patients with VAP die vs. 27% of ventilated patients without VAP* 71.4% of VAP patients with multi-resistant organisms die. A single VAP adds an average cost of: $86, *Fagon JY, et al Am J Med. 1993;94:

8 Congestive Heart Failure: A Well Known Killer + Approximately 5 million Americans suffer from CHF + Incidences of CHF have increased 35% in past 25 years + 1,000,000 hospital admissions/year; 30-60% are readmissions + In 2007, 616,067 cardiac related deaths + 32 billion dollars spent on care for CHF each year + CHF is a direct or contributing factor in up to 250,000 deaths per year + That s 685 per day (29 per hour)

9 Congestive Heart Failure: A Well Known Killer A significant number of these deaths can be prevented with early, aggressive intervention. That early, aggressive intervention needs to start in the field, with our EMS partners. CPAP is a literature validated, valuable weapon in this acute process. Not every patient needs a tube!!! BUT.

10 Financial Impact of CHF Remember, a single VAP adds a minimum cost of: $86, On average, the first 24 hours of mechanical ventilation costs somewhere around: $8, The circuit for a CPAP device costs about $70.00

11 There Is A Whole New Wave Of CHF Pts. Coming: The Baby Boomers!! (The Class of 46-64) aka: The Silver Tsunami 69,500,000 Eligible To Retire By 2020

12 CPAP: Theory and Application: Provide Mechanical Ventilation via full facemask in specific patient populations: -Avoiding intubation -ETT related problems -Decreasing infection potentials -Psychological side effects of intubation This results in: -Shortened hospital length of stay -Decreased hospital costs -Less potential for nosocomial infection

13 Advantages of CPAP: Flexibility: in initiating, interrupting, and discontinuing mechanical ventilation Decreases: the need for invasive monitoring once in the E.C. and ICU admission Preserves: speech and swallowing Improves: patient comfort Positive psychological advantage to the patient

14 Advantages (cont d): + Decreased sedation requirements once in the E.D. and ICU admission + Low pressure ventilation + Low risk in postponing ETI should short term CPAP fail

15 Patient Selection (Inclusive): Patient s who are alert and cooperative COPDer s with acute hypoxemia and/or hypercarbia Acute pulmonary edema or CHF patients who, with diuresis/dialysis will almost always improve dramatically Patient s with hypoxemia refractory to high percentage O 2 by NRB or multiple appliances

16 Patient Selection (Exclusive): + Patient s who are hypotensive + Patient s with significant cardiac arrhythmia s + Patient s at high risk for aspiration, including those with: - mental obduntation - impaired swallowing - acute abdominal process

17 CPAP Pearls: + CPAP is a very effective therapy if properly administered. A total commitment on the part of the medical team is needed to enhance its chance of success + CPAP is absolutely a labor intensive therapy and must be approached as such or not initiated at all.

18 Why Bother In The Pre-hospital World? First of all, Why Not??? Not everyone needs a tube Reduces patient exposures Decreases length of hospital stay Increases patient satisfaction Because it is the right thing to do in specific patients

19 Payor Mixes Are At Critical Mass Hospital A: 71% Hospital B: 54% Hospital C: 55% Hospital D: 69% Pre-Hospital Rescue CPAP Can Assist With This

20 So, Does It Work?

21 The Houston Experience field intubated patients received per year got extubated in <24 hours + Average cost of first 24 O of mechanical ventilation: ~$8,000.00

22 Cost Savings Theory: + If just 100 of those did not get intubated, we were looking at a minimum decrease in costs of approximately $800, less exposures to the dangers and potentials of intubation and mechanical ventilation is just plain huge

23 Partnering With Our EMS Systems: Thinking Outside Of The Box MHHS & HFD : + 51 CPAP units supplied free of charge + HFD stocks replacement circuits + For every patient brought to one of the MHHS facilities on CPAP, we exchanged a replacement circuit for theirs + Win-Win for everyone, especially the patient + Excellent public relations tool for the hospitals, the EMS system and the city

24 The First Year: The Data Does Not Lie Total Patients Received at MHHS Facilities: 364 Number Of Patients Intubated: 64 Success Rate: 83% Minimum Cost Savings (2006): $2,400,000 Minimum Cost Avoidance (2010): $4,

25 And After The Event: The patient is still at risk!!

26 Final Thoughts: Traditional oxygen appliances are frequently ineffective in specific patient subsets Pre-hospital Rescue CPAP is a universally underutilized procedure EMS systems and hospital systems need to explore partnerships, including funding opportunities Thinking outside the box will significantly and positively impact patient outcomes, community relations and the financial stability of our hospitals

27 Almost Done, But First: Cannot Finish Without My Pulpit Moment

28 Respiratory Care at the Fork in the Road The Road To Extinction? Surviving & Thriving Which Way Are YOU Headed?

29 And If You Don t Believe Me.

30 Our Profession Is In Big Trouble: Indiana & California Survive Sunset Law Challenges Kentucky One Health System Texas Facing Sunset Commission Recommendation To Deregulate Respiratory Therapy

31 Just The Facts Ma am We Are An Apathetic Profession Nationally: 150,000 + Therapists ~1/3 Belong To The AARC Nursing Sends Many Lobbyists To DC We Send 3

32 Is It The Cost? AARC Cost Of Membership As Low As $78.50 This Almost Always Includes a State Level Membership And The Benefits!!! Membership = Survival = Recognition = Credibility = Prosperity

33 The Final Word: Remember The Most Expensive Words In Medicine: But That s The Way We ve Always Done It

34 Questions? Michael J Hewitt, RRT, ACCS, NPS, RCP, FAARC, FCCM mhewitt@lifespan.org

35 Next webinar + 2-part webinar series: + 30 Day COPD Readmissions and Pulmonary Rehab + Wednesday, August 20, Considerations for Building a COPD Coordinated Respiratory Care Model + Wednesday, September 17, CEU credits if you attend both! + Register at: +