Chest
Volume 99, Issue 1, January 1991, Pages 205-208
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The Noninvasive Respiratory Care Unit: Patterns of Use and Financial Implications

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Clinical, socioeconomic, and ethical dilemmas have prompted reevaluation of traditional methods of providing intensive care. Six years ago, we established a noninvasive respiratory care unit (NRCU) for selected patients in need of intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation. One impetus for the formation of the NRCU was the expectation that it might prove to be a less costly alternative to the intensive care unit (ICU) for selected patients. We reviewed data from all patients admitted to the NRCU from July 1, 1987 through June 30, 1988 to identify characteristics of the patient population and to evaluate potential cost savings. During one year of operation, 136 patients were admitted to the unit, 107 of whom were mechanically ventilated. Overall, hospital costs for these patients exceeded payments by $1,519,477. Losses were greatest for mechanically ventilated patients and those for whom Medicare or Medicaid were the primary payors. Daily costs of care for mechanically ventilated patients were $1,976 lower in the NRCU than in the medical intensive care unit (MICU). We conclude that the NRCU represents a cost-effective approach to the care of substantial numbers of patients requiring specialized respiratory care. (Chest 1991; 99:205–08)

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UNIT DESCRIPTION

The NRCU is an 11-bed unit with the capacity to care for eight patients receiving continuous mechanical ventilation. The NRCU is located on one of our general medical units. The private rooms comprising the NRCU were modified to accommodate the needs of our patient population. These modifications included upgrading of the electrical system; installing a rail system to accommodate respiratory equipment, supplies, and gases; and installing surveillance cameras and bedside ECG monitors. Room

METHODS

All patients admitted to the NRCU at Rush-Presbyterian-St. Luke's Medical Center between July 1, 1987 and June 30, 1988 were identified. Demographic information, diagnoses, and outcomes were available for each patient from a unit log book. Data regarding length of hospitalization, duration of ventilation, hospital costs, payments, payors, and profit/loss calculations were obtained through an in-house computerized data base (This system is capable of merging medical record abstracts with

Patient Population

In 1988, a total of 136 patients were cared for in the NRCU (47 percent men, 53 percent women). More than half of the patients were 60 to 80 years of age (Fig 1). The mean age was 60.6 years (SD = 15.9; range = 16–87). Medicare was the primary payor source for 61 patients (45 percent) (Fig 2). The average length of hospitalization for these patients was 26.6 days (SD = 26; range 1–183). One-hundred seven (78 percent) of the patients received mechanical ventilation for an average of 16.2 days

DISCUSSION

In this study, we have documented a decrease in the daily costs of care associated with the transfer of mechanically ventilated patients from the MICU to the NRCU. Had the NRCU not been available at our institution and had these patients remained in the MICU for the duration of mechanical ventilation, our analysis suggests that costs of care would have increased by up to $20,000 per patient.

The cost savings in the NRCU as compared to the MICU persisted after subtracting room cost differences

CONCLUSIONS

Providing intensive care for Medicare and Medicaid recipients who require long-term ventilator support is financially draining to hospitals. Appreciation for the high costs and limited outcomes of intensive care has prompted investigation of other care delivery systems that could provide quality care at a more reasonable cost. We have found the NRCU to be an important advance toward this goal. We have demonstrated that substantial cost reductions can be realized by expediting the transfer of

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