Original Article
The Chronic Ventilator-Dependent Unit: A Lower-Cost Alternative to Intensive Care

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Objective

To evaluate the fixed costs and patient outcomes of a specialty hospital unit for medically stable ventilator-dependent patients. The chronic ventilator-dependent unit (CVDU) was established to facilitate early dismissal from costly intensive care unit (ICU) hospitalization for patients requiring continued specialized care.

Patients and Methods

We carried out a cost analysis of the various ICUs that transferred patients to the CVDU by year from 1993 through 1998. In addition, direct and indirect costs for the CVDU were established by year for the same period. We then calculated the cost effect of transferring these patients for care from each high-cost ICU to the lower-cost CVDU. Ventilator weaning and mortality rates were also determined.

Results

During the 6 years of this study, $4,832,551 in patient care costs were saved by transferring care for 964 patients from ICUs to the CVDU. Ventilator weaning was successful in 64% of 549 patients, and mortality was 7% in the same patient group.

Conclusions

Care in the CVDU yielded lower fixed costs per patient-day, and CVDU care was comparable to ICU hospitalization.

Section snippets

PATIENTS AND METHODS

In 1990, the CVDU opened at Saint Marys Hospital to move medically stable, ventilator-dependent patients from ICUs to an environment with a strong focus on physical rehabilitation. An additional aim of this unit was to wean patients from mechanical ventilation or to return them to their homes on nocturnal mechanical ventilation. This unit was funded by HCFA until January 1995 with specific criteria for admission.1 In 1995, the mission of this unit was expanded to include patients who were being

RESULTS

During the 6 years of this study, 964 patients were admitted to the CVDU for a total of 12,075 patient days. Admissions included 420 newly ventilator-dependent patients with tracheostomies, 339 patients who were being started on noninvasive ventilators or tracheostomy/intensive respiratory care patients, and 205 nonunit patients who were admitted from outpatient status (Table 2). The cost savings to Saint Marys Hospital of transferring these patients out of ICUs and into the CVDU by year is

DISCUSSION

In the past 10 to 15 years, alternative options to ICU care for certain acute care patients have been developed. These include noninvasive respiratory care units, ventilator-dependent units, and various combinations of this theme. A health technology case study by the Office of Technology Assessment published in 1984 estimated that the cost of intensive care medicine accounted for 20% of hospital-associated costs.2 Since 1984, the national phenomenon of a reduction of the oversupply of hospital

SUMMARY AND CONCLUSIONS

At Mayo Clinic Rochester, we opened a ventilator-dependent rehabilitation unit in 1990, which has been highly successful with a 7% mortality rate and 64% weaning success rate in the first 9 years of the unit's operation. Subsequent to opening, the CVDU was enlarged, and the unit broadened its mission to include tracheostomy care in the nonmechanically ventilated patient, noninvasive ventilation, and intensive respiratory care. The data presented on the financial effect of this unit for the

ACKNOWLEDGMENT

The financial and patient day data for the ICUs and CVDU were provided by Craig C. Collins and Joyce A. Even, Mayo Clinic Rochester Management Accounting, with the assistance of Jeffrey C. Sigrist and Ronald W. Grousky, Mayo Foundation Accounting.

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This study was supported in part by Health Care Financing Administration project grant 29-P-99424/1, Demonstration Project Units for Ventilator Dependent Units in Acute Care Hospitals.

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