Introduction Intensive care (ICU) admission is usually mandatory for patients requiring mechanical ventilation (MV). A proportion of patients require prolonged MV (PMV). In other countries, specialised weaning units allow stable PMV patients to be discharged from the ICU. These units offer cost savings because of lower staff-to-patient ratios. A recent report of UK ICU services recommended that hospitals review the need for specialised weaning centres locally.
Aims To assess the feasibility of establishing a weaning unit in a Scottish health board region and to model the potential impact on ICU services.
Methods All admissions to the three adult ICUs in our health board requiring PMV (≥21 days MV) during a 2-year period (2005–2006) were extracted from the Scottish Intensive Care Audit Group database. Four hypothetical weaning units were modelled using different admission criteria, ranging from Unit-A, which required a prolonged period of stability prior to transfer from ICU to the weaning unit (7 days free of both cardiovascular support (CVS) and renal replacement therapy), to Unit-D (2 days free of CVS only). The date of eligibility for each PMV patient for each unit was determined. We used remaining length of stay (LOS) in ICU after eligibility to calculate occupancy rate, refusal rate and net cost saving, varying unit capacity from 1 to 8 beds.
Results During 2005–2006, 126 patients required PMV. Of these, the number eligible for transfer to a weaning unit varied from 101 (Unit-A) to 117 (Unit-D). Mean ICU LOS after reaching eligibility varied from 14.9 to 15.3 days. Occupancy rates for Unit-A ranged from 90.8% to 25.5% (1-bed to 8-bed unit) and for Unit-D from 93.3% to 30.5%. Refusal rates for Unit-A ranged from 88.1% to 0%, and for Unit-D 92.3% to 0%. The greatest cost saving was for Unit-D with 3 beds (£344 025) (Abstract S9 Figure 1).
Conclusion PMV patients use 25% of ICU bed-days in our region. Establishing a 3-bed weaning unit could lead to a reduction of 800 ICU bed-days, a net annual cost saving of £340 000, and acceptable occupancy (70%) and refusal (30%) rates. Establishing such a unit would be feasible in our health board region.
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