Respiratory compromise is an increasing concern for many hospital executives as it leads to negative patient outcomes and escalated costs. At the Becker's Hospital Review 7th Annual Meeting, Lee Fleisher, MD, chair of anesthesiology and critical care at the University of Pennsylvania's Perelman School of Medicine, outlined why early intervention and monitoring is essential to decrease respiratory compromise.
"As chair, you move into a new space of what are the complications driving costs," Dr. Fleisher said. "We are now seeing respiratory compromise is a major area of concern. As we go forward, it is important to engage physicians to focus on problems that cause complications."
Dr. Fleisher cited a study titled "Healthcare utilization and costs associated with S. aureus and P. aeruginosa pneumonia in the intensive care unit: a retrospective observational cohort study in a US claims database" to illustrate the repercussions associated with respiratory compromise. The study found patients with S. aureus had a mean hospital stay of 37.9 days compared to the general population (7.2 days). Patients with P. aeruginosa pneumonia had a mean hospital stay of 55.4 days. In addition to length of stay, S. aureus or P. aeruginosa pneumonia was associated with a higher rate of mechanical ventilation, higher mortality as well as higher total hospitalization cost.
"As people are studying this, there is a profound post-ICU syndrome that develops in these patients," Dr. Fleisher explained. "If you talk to patients, you will see they can talk about their ICU stay for years. It is very similar to Posttraumatic Stress Disorder. This is something we need to address and we have no clue how to address it today."
While there is no simple solution, physicians can work to identify patients at higher-risk of developing respiratory compromise. Dr. Fleisher and fellow researchers conducted a study titled "Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures." In the study, researchers set out to discover if they could identify a subset of high-risk patients and intervene to make a difference in their outcomes. Dr. Fleisher and his colleagues found if you prevent high-risk patients from having complications, hospitals can significantly improve their bottom line.
A key patient population hospitals often miss is undiagnosed sleep apnea patients. Physicians should flag patients who fail the screening questionnaire and the hospital may consider monitoring them differently when prescribing opioids. Sleep apnea patients are at a greater risk for respiratory complications, which will likely results in increased length of stay and cost.
"People are giving narcotics as a way to improve pain, but that may be driving other negative consequences," Dr. Fleisher said. "We need to do a better job of setting patient expectations for patient relief. Patients need to know what kind of pain they will have because we are seeing an epidemic of opioid overdoses in the hospital."
Monitoring patients is essential to enhancing patient outcomes, especially if a patient is taking opioids. Dr. Fleisher and his Perelman School of Medicine colleagues analyzed a subset of patients at a magnet hospital versus a non-magnet hospital to decipher the importance of patient monitoring. If patients were deemed-low risk, a magnet hospital had a minimal effect on their outcomes. However, as patients became sicker, researchers found a substantial benefit for those treated at magnet hospitals. Magnet hospitals yielded enhanced patient outcomes, lowering ICU admissions and costs.
"If you are practicing in an area with a lot of obesity and sleep apnea patients who are undergoing major complications, you should have better nursing to bed rations," Dr. Fleisher said. "Monitoring your patients better will have a profound effect."
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