Implementing a Bedside Percutaneous Tracheostomy and Ultrasound Gastrostomy Team Reduces Length of Stay and Hospital Costs Across Multiple Critical Care Units in a 1500 Bed Tertiary Care Center.

Background

Thousands of critically ill patients every year in the United States receive tracheostomy and gastrostomy procedures. Recent research has investigated the benefits of a combined team approach to these procedures, with associated decreases in length of stay (LOS) and hospital costs. This study's objective was to determine if implementing a bedside percutaneous tracheostomy and percutaneous ultrasound gastrostomy (PUG) team would reduce LOS and hospital costs. Design and

Methods

This retrospective chart review compares the impact of implementing an ICU bedside percutaneous tracheostomy and PUG service team to the hospital's previous workflow (ie, pre-implementation). Inclusion criteria were adult patients with Ventilator Dependent Respiratory Failure (VDRF), a clinical indication for both procedures while admitted to the ICU and received both tracheostomy and gastrostomy procedures while admitted to the hospital. Pre- and post-implementation groups were compared across patients' demographics, clinical characteristics, and outcomes. ICU LOS, hospital LOS and total hospital costs were the primary outcome measures.

Results

A total of 101 adult critically ill patients were included in the analysis; 49 patients were in the pre-implementation group and 52 patients in the post-implementation group (ie, PUG group). Patients in the PUG group had a significantly shorter mean ICU LOS and hospital LOS, 10.9- and 14.7-day reductions respectively (p = 0.010, p = 0.006). PUG group patients also had a significant reduction in total hospital costs, a per patient cost savings of $34 778 (p = 0.043).

Conclusions

This study supports implementing a bedside percutaneous tracheostomy and PUG team to reduce LOS and total hospital costs in patients with VDRF.