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- Title
GROWTH IN UTILIZATION OF HFNC IN A PEDIATRIC HOSPITAL.
- Authors
Salyer, John; Yun, Amber; Smith, Stephen; Roberts, Joan; Crotwell, Dave; Diblasi, Robert
- Abstract
BACKGROUND: Anecdotal evidence indicates that demand for HFNC therapy is growing at a rate that does not appear to be related to the known benefits of HFNC. We sought to quantify this growth in utilization. METHODS: We combined retrospective data from multiple sources to study HFNC use; 1) a Pt. safety dashboard (Tableau Software, Seattle WA) which was connected to our Enterprise Data Warehouse (EDW), which derives data from our 2) electronic medical record (Cerner, Kansas), and 3} administrative database (Epic Systems, Madison WI). The Pt. safety dashboard data range from Feb-2012 through Apr-2015. From the dashboard we obtained the proportion (%) of HFNC" patient days to all in-patient days (excluding psych). This metric is part of the routine daily assessment of risk for our inparicnt populations. HFNC procedural billing was obtained from che EDW for 2010-2015. Data were then treated to yield: 1) total number of billed HFNC procedures per year, 2) HFNC days as a proportion (%) of all in-patient days, and 3) total HFNC charges per year. Growth rates were calculated. Pricing (charge) data were inflation adjusted to keep constant 2010 dollars. RESULTS: The ratio of HFNC Pt. days to all Pt. days ranged from 2.1% in 2012 to 11.6% in 2015. There was a 110% increase in HFNC days as a proportion of all patient days comparing 2012 to 2015. Total HFNC days increased 290% from 2010 to 2015 (72% growth per year). Total HFNC charges increased 206% from 2010 to 2015 (52% growth per year). Conclusion: Utilization of HFNC has grown dramatically. Growth of this magnitude strains logistic and staffing systems and increases costs. We know of other pediatric hospitals that use almost no HFNC. We speculate that some of this utilization may be inappropriate. It is also possible that the increase in HFNC days has resulted in a decrease in the utilization of other forms of invasive and non-invasive respiratory support. The authors recommend a value-directed method of reducing unwarranted utilization of HFNC. Next steps include the use of our EDW to create a Tableau dashboard for studying and managing HFNC utilization.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF45
- ISSN
0020-1324
- Publication type
Academic Journal