Abstract 131: Reduction Of Inhaled Nitric Oxide Utilization And Cost While Maintaining Quality Patient Care

Background: There is evidence that decreasing practice variation and following clinical guidelines improves patient outcomes and reduces cost. Inhaled nitric oxide (iNO) is an effective but expensive treatment for pulmonary hypertension and right heart failure in patients with congenital or acquired heart disease. Our primary aim was to implement standardized initiation and weaning guidelines for iNO usage in the cardiac intensive care unit (CTICU). Secondary aim was to reduce utilization and cost of iNO while maintaining quality patient care. Methods: Retrospective review of patients from Jan 2011-Dec 2012 who received iNO in the CTICU including outcomes, utilization and cost. Implementation of standardized initiation and weaning guidelines for iNO usage began in Jan 2012. Quality tools utilized during project development and implementation included Fishbone diagram, Key Driver diagram, Run charts and Control charts. Results: From Jan 2011-Dec 2011, 34 patients (6% of CTICU admissions, n=547) received iNO for an average of 177+127 hrs (range 2-661 hrs). Mortality of patient who received iNO was 50%. Total cost of iNO was $335,204; average cost per patient was $9859. Standardized initiation and weaning guidelines for iNO usage were implemented in Jan 2012. From Jan 2012-Dec 2012, 40 patients (7% of CTICU admissions, n= 554) received iNO for an average of 125+135 hrs (range 2-657 hrs). Mortality of patient who received iNO was 20%. Total cost of iNO was $380,823; average cost per patient was $9520. Initiation guideline compliance improved from 83% in 1st quarter to 86% in 4th quarter of 2012; weaning guideline compliance improved from 17% in 1st quarter to 79% in 4th quarter of 2012. There was an 8.3% increase in cost of iNO per hr from 2011 to 2012. Conclusions: Implementation of standardized initiation and weaning guidelines for iNO in the CTICU was successful in reducing iNO utilization (from 177+127 hrs/patient to 125+135 hrs/patient) and cost per patient (cost of iNO/hr increased) while maintaining quality patient care. However, the change was not statistically significant.