Partnership successful at weaning patients off ventilators

The Progressive Care Unit at Tampa General Hospital has generated impressive results, including an 83% ventilator weaning rate and 75% reduction in readmissions.

A unique partnership at Tampa General Hospital is generating positive results for patients on ventilators.

Ventilator-dependent patients are medically complex and often have multiple morbidities. Providing care for these patients is costly, and they have extended lengths of stay compared to many hospitalized patients.

In a partnership with Boca Raton, Florida-based Special Care Unit, Tampa General Hospital operates a Progressive Care Unit to wean patients off ventilators. "It is separate from an ICU. It is a step-down level of care from an ICU. It has its own dedicated area in the hospital," says Sam Nimah, CEO of Special Care Unit.

The Progressive Care Unit has staff members from Tampa General Hospital and Special Care Unit, he says. "It is a jointly staffed unit, with staff from Tampa General as well as Special Care Unit to provide a unique opportunity for ventilator-dependent patients to wean off the ventilator at a rate of greater than 80%. It is staffed with dedicated nurses, respiratory therapists, physical therapists, occupational therapists, speech-language pathologists, and case managers. All of the staff are dedicated to the unit."

The Progressive Care Unit provides an exceptional patient experience, with daily intensive rehabilitation efforts, Nimah says.

"Most hospitals have a rehabilitation department that is responsible for rehabilitation opportunities and consults throughout the hospital. They may have to go to dozens of patients on a given day across the hospital. But hospitals are controlled chaos—there are multiple activities going on at any given moment. So, a physical therapist may show up in a patient's room, and they may be off getting a CT scan, or they may have had a rough night and they are sleeping. In those circumstances, the physical therapist has to move on to the next patient. In the Progressive Care Unit, we have a dedicated team, so if a patient is not ready for their rehab it is no problem—we will be there when the patient is ready."

The consistency of staffing is a crucial part of the patient experience at the Progressive Care Unit, he says.

"On average, our patients are with us for about three weeks. We become their family, and they become our family. The average length of stay in a hospital is only a few days. If you have nurses working three shifts in a row—one at day and one at night—a patient will rarely see more than one set of nurses during their stay. But when a patient is in a hospital for three weeks, the patient can rotate through multiple nurses' shifts. Our respiratory therapists, our physical therapists, our occupational therapists, and our nurses are all on the unit six days a week. They see the family. The patient sees the team working together every day."

The patient experience at the Progressive Care Unit includes an intensive level of rehabilitation that is not common at acute-care hospitals, Nimah says. "The key part of this is that every patient interaction can become a rehabilitation opportunity. With a team that is dedicated to this unit, we go far beyond what payers will pay for. For example, one physical therapy session per day is reimbursable by Medicare. We go far beyond that—turning every patient interaction into a potential rehabilitation opportunity."

The rehabilitation activities in the Progressive Care Unit include activities of daily living, range of motion, and walking, he says. "We just had an example where we had a physical therapist, occupational therapist, respiratory therapist, and a nurse all walking with a patient who was on the ventilator and had multiple intravenous connections. They were walking with the patient to get rehabilitation accomplished. There are a lot of rehabilitation hindrances when a patient is on a ventilator with IV drips—it can get very complicated. But we have a whole team that is dedicated to working with the patient together. It's a rare opportunity in any hospital."

PLAYING AN IMPORTANT ROLE DURING THE CORONAVIRUS PANDEMIC

The Progressive Care Unit has helped Tampa General Hospital post impressive clinical outcomes for COVID-19 patients, says John Couris, president and CEO of the hospital. "During the height of the pandemic, our resources were stretched. We were able to transition the medically complex, ventilator-dependent patients to breathing independently smoothly and safely with the support of the Progressive Care Unit.  When you look at the outcomes for patients with COVID-19 at Tampa General Hospital, we have been in the top quartile for clinical outcomes, and we have been in the top decile for length of stay. I attribute part of that success to having the relationship with Special Care Unit."

The Progressive Care Unit is well-suited to weaning COVID-19 patients off ventilators, he says. "Specific to COVID-19, the Progressive Care Unit contributed in a significant way to better results with a lower length of stay for our COVID patients who were being weaned off ventilators. With the Progressive Care Unit, we had quality, better outcomes, better safety, and better efficiency and effectiveness for our patients."

DELIVERING GOOD RESULTS

Reducing length of stay is a primary benefit of the Progressive Care Unit, Nimah says. "You do not typically have a respiratory therapist 24/7. You do not typically have physical therapists, occupational therapists, and speech-language pathologists all converging on one unit. For the patients we serve, we reduce length of stay by up to 12 days. That is how our service is paid for—it is paid for through efficiency and effectiveness of care."

The Progressive Care Unit generates several positive results, he says.

  • The unit has weaned patients off ventilators at a rate of 83% over the past three years. 
     
  • The unit has reduced length of stay by six and 12 days, respectively, for DRG 003 and DRG 004. DRG 003 is a patient with a tracheostomy who is on a ventilator for more than 96 hours, with additional complications such as extracorporeal membrane oxygenation. DRG 004 is a patient with a tracheostomy who is on a ventilator for more than 96 hours.
     
  • The unit has reduced hospital readmissions by more than 75%. 
     
  • The unit increased hospital margin by about $2.3 million in fiscal year 2021.

The partnership between Tampa General Hospital and Special Care Unit has been beneficial for patients and the hospital, Couris says. "It is a contractual relationship that is predicated on volume and quality. It is fair market value. It is commercially reasonable. It is driven by the activity that Special Care Unit does, the volume that they handle, plus the quality and clinical outcomes that they are responsible for achieving in collaboration with us."

Special Care Unit has a ventilator-weaning partnership with one other hospital—University of Alabama at Birmingham Hospital.

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