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Program reduces postoperative respiratory problems


A simple and inexpensive postoperative pulmonary care program reduces the likelihood of respiratory complications such as pneumonia and ventilator dependency, according to a study.

“Few data exist for best-practice guidelines regarding postoperative pulmonary care,” David McAneny, MD, FACS, a study coauthor and associate professor of surgery at the Boston University School of Medicine, said in a news release. “There is a lot of literature about ventilator-associated pneumonias, but little is written about standard postoperative pulmonary care.”

McAneny said BUMC developed a program called “I COUGH” to decrease the incidence of pulmonary complications. I COUGH stands for Incentive spirometry, Coughing/deep breathing, Oral care, Understanding (patient and staff education), Getting out of bed at least three times daily and Head of bed elevation.

“Our efforts were aimed at correcting basic nursing interventions as well as intensified patient and family education before the operation and in the immediate postoperative period,” McAneny said.

After implementation, the researchers found significant reductions in the likelihood of pneumonia after surgery and of unplanned intubation. They also found a significant decline in venous thromboembolic complications.

“By virtue of the fact that there was a greater focus on mobilizing patients out of bed soon after their operations and on standardizing their pulmonary care, in addition to an early program of risk-stratified prophylaxis against VTE complications, we concomitantly saw a dramatic increase in venous thromboembolic complications,” McAneny said. “We are excited about these results.”

In August 2010, the initiative was implemented by the hospital’s multidisciplinary team composed of surgeons, surgical residents, internal medicine physicians, nurses, quality improvement and infection control experts, respiratory therapists and physical therapists. “Because the program is hard-wired into the computerized physician orders, the I COUGH program steps are automatically ordered on all patients,” McAneny said.

“The costs of these serious complications can range from $18,000 to $52,000 per event, and we estimate at least $1 million in savings at our institution from these interventions,” he added.

The study was presented Oct. 4 in Chicago at the American College of Surgeons’ annual meeting.


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