Abstract
BackgroundMechanical ventilation is a life supporting modality increasingly utilized when caring for severely ill patients. Its increasing use has extended the survival of the critically ill leading to increasing healthcare expenditures. We examined changes in the hospital-wide use of mechanical ventilation over 20 years (1997–2016) in two Israeli hospitals to determine whether there were specific patterns (e.g. seasonality, weekday vs. weekend) and trends (e.g. increases or decreases) among various hospital departments and units.MethodsRetrospective analysis of prospectively collected data on all mechanically ventilated patients over 20-years in a two-hospital Israeli medical system was performed. Data were collected for each hospital unit caring for ventilated patients. Time-series analysis examined short and long-term trends, seasonality and intra-week variation.ResultsOver two decades overall ventilator-days increased from 11,164 (31 patients/day) in 1997 to 24,317 (67 patients/day) in 2016 mainly due to more patients ventilated on internal medicine wards (1997: 4 patients/day; 2016: 24 patients/day). The increases in other hospital areas did not approach the magnitude of the internal medicine wards increases. Ventilation on wards reflected the insufficient number of ICU beds in Israel. A detailed snapshot over 4 months of patients ventilated on internal medicine wards (n = 745) showed that they tended to be elderly (median age 75 years) and that 24% were ventilated for more than a week. Hospital-wide ventilation patterns were the weighted sum of the various individual patient units with the most noticeable pattern being peak winter prevalence on the internal medical wards and in the emergency department. This seasonality is not surprising, given the greater incidence of respiratory ailments in winter.ConclusionsIncreased mechanical ventilation plus seasonality have budgetary, operational and staffing consequences for individual hospitals and the entire healthcare system. The Israeli healthcare leadership needs to plan and support expanding, equipping and staffing acute and chronic care units that are staffed by providers trained to care for such complex patients.
Highlights
Mechanical ventilation is a life supporting modality often employed in the care of severely ill patients
This study explores the prevalence patterns of mechanical ventilation using a dataset collected over a 20-year period (1997– 2016) in a two-hospital Israeli medical system that includes a tertiary care medical center and a community hospital
We examined hospital-wide ventilator use and patterns of ventilation in various areas of the hospital ranging from the surgical intensive care unit (ICU) to the internal medicine floors
Summary
Mechanical ventilation is a life supporting modality often employed in the care of severely ill patients. In Israel, many seriously ill patients are mechanically ventilated in internal medicine wards due to a shortage of ICU beds [10, 12,13,14]. Among the hypotheses tested was that over 20 years there have been substantial increases in the prevalence of mechanical ventilation Another hypothesis examined was that the overall pattern of mechanical ventilator utilization is seasonal, this pattern is due to internal medicine and not surgical activity. Mechanical ventilation is a life supporting modality increasingly utilized when caring for severely ill patients. We examined changes in the hospital-wide use of mechanical ventilation over 20 years (1997–2016) in two Israeli hospitals to determine whether there were specific patterns (e.g. seasonality, weekday vs weekend) and trends (e.g. increases or decreases) among various hospital departments and units
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