The experience of four outcomes managers: an institutional approach to weaning patients from long-term mechanical ventilation.

Patients who require prolonged mechanical ventiBackground lation, regardless of the condition that necessitates ventilatory support, are identified as high resource consumers of health care. In many cases, institutions charged with their care find that reimbursement from third-party payers often falls short of the actual cost of care, leading to substantial financial losses. In an effort to improve the cost of care of patients who require long-term mechanical ventilation (LTMV), systematic institutional initiatives designed to improve the care, and thus the outcomes, associated with prolonged ventilation have been suggested [1–8]. This article describes a successful institutional initiative that uses advanced practice nurses (APNs) in the role of outcomes managers (OMs) to manage and monitor patients who require LTMV. This article describes the historical background, the selection and qualifications of the APNs, the process APNs use to manage and monitor the patients, and role challenges and associated outcomes of the program.