Najam Siddiqui, DO
LSU Health- Shreveport
Shreveport, Louisiana
Disclosure information not submitted.
Robert Walter, MD, MPH,
Professor and Division Chief of Pulmonary and Critical Care Medicine
Louisiana State University Health Sciences Center, United States
Disclosure information not submitted.
Nasim Motayar, MD
Assistant Professor of Clinical Medicine
n/a, United States
Disclosure information not submitted.
Title: Reduction of Ventilator Associated Events (VAEs) in the ICUs of an Academic Teaching Hospital
Introduction: In 2013, the Center for Disease Control established a definition for Ventilator Associated Events to define tracking of episodes of sustained respiratory deterioration in mechanically ventilated patients after a period of stability or improvement. VAEs included Ventilator Associated Conditions (VAC), Infection related Ventilator-Associated Complication (IVAC), and Possible Ventilator Associated Pneumonia (PVAP). VAEs are associated with longer length of mechanical ventilation, increased costs and adverse patient outcomes. Common etiologies are identified as: ARDS, pneumonia, atelectasis, and pulmonary edema. Most of these events are usually preventable if identified and addressed promptly. Evidence based practices have been proposed aimed at reducing length of mechanical ventilation and avoiding need for mechanical ventilation through the use of Non-invasive mechanical ventilation and High Flow Nasal Cannula. One of the factors not addressed is lack of expertise of young trainees for early identification and intervention to address causes of respiratory instability.
Methods: Our critical care service developed a team approach to reducing VAEs. This involved a collaboration between the respiratory department as well as critical care physicians and trainees. A program was developed to flag and identify any time criteria was met to trigger a VAE using electronic medical record reporting software. This included daily screening. All respiratory therapists and attending physicians were educated on criteria for a VAE.
Results: Prior to the implementation of the program, the critical care department reported a total of 14 VAEs per year. Based on that, the expected rate of VAEs in 6 months is 7 events. After implementing this program, the number of VAEs was reduced to 1 (85% reduction). This has resulted in a cost reduction of $282,000. Based on our current data, the projected cost reduction in the upcoming fiscal year is approximately $611,000. This has positive implications for patient outcomes.
Conclusions: Our critical care team successfully implemented a program to standardize our institution’s approach to VAEs thereby reducing the number of VAEs by 85% in a quarter. We recommend other institutions to consider adopting a similar standardized multi-disciplinary team approach to addressing potential VAEs