Decreasing Ventilator Days Utilizing a Progressive Upright Mobility Program

Purpose:
Mechanical ventilation costs $1522 a day. Mobilization prevents complications due to bedrest in ICU patients. One complication is VAP which increases a patient's hospital cost $40000. The goal of this study was to decrease ventilator days in a MICU using Progressive Upright Mobility(PUM).

Significance:
The significance of this study is the reduction in patient ventilator days. This improves muscle strength, enhances mood, decreases stress and fatigue and allows ability to resume ADL's. Early mobility decreases incidence of skin breakdown and VAP. Hospital costs are reduced over $1, 000,000.

Strategy and Implementation:
A champion team of nurses in a 22 bed MICU designed and implemented the study. All ventilator patients were included in the study using therapeutic beds already in place. A CLRT guideline for patients with ARDS and ALI was devised. These patients would advance to PUM when stable. A guideline was written for ventilator dependent patients to participate in a 6 step PUM program, beginning with a 45 degree tilt to a goal of standing, stepping into a chair. The MICU staff was educated on use of the specialty beds, the guidelines and data collection tools. Nurses ensured that a step was implemented every 8 hours and more frequently as tolerated by the patient. The patient advanced to the next step as hemodynamic and physical tolerance was demonstrated. A data collection tool was used to evaluate patient progress daily by the nurse. It was placed at the bedside to ensure compliance. Data on ventilator days and VAP rates was calculated monthly as per the institution's standard.

Evaluation:
Four months after the study's initiation, an 8% decrease in ventilator days was noted compared to the previous year. The next four months showed an 8.5% decrease in ventilator days compared to the previous year. This comparative analysis yields a decrease by 254 ventilator days.

Implications for Practice:
A cost savings of $386,588 was calculated using the hospital's ventilator day cost of $1522/day. This reduction in ventilator days could lead to an annual cost savings of $1,159,764 by potentially reducing ventilator days by 762 days.