How One Boston Medical Center Program Saves Lives and Money

All it takes is some simple post-op activities like deep coughing to decrease risk of major complications.

 

coughing drawing

Coughing drawing via Shutterstock

Respiratory complications, including pneumonia, are some of the most common complications that occur after an operation. Dr. David McAneny, a surgeon at Boston Medical Center (BMC) and a professor at Boston University School of Medicine, says that there was not a lot of existing data on the best practices for post-op pulmonary care. “There is a lot of medical literature about ventilator-associated pneumonias, but little is written about standard postoperative pulmonary care,” McAneny says.

Data from the American College of Surgeons National Surgical Quality Improvement Program showed that BMC had a greater than expected incidence of pulmonary complications, so BMC developed the I COUGH program to decrease these incidents.

I COUGH stands for:

  • Incentive spirometry (a test measuring lung function)
  • Coughing/deep breathing
  • Oral care
  • Understanding (patient and staff education)
  • Getting out of bed at least three times daily
  • 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.

The I COUGH 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 says. “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.”

The goal of the program is to decrease the number of post-op respiratory complications hospital-wide by at least 50 percent and so far, the program has been working. In just two years since I COUGH was implemented, BMC has seen a dramatic decline in venous thromboembolic (a blood clot that forms within a vein) complications after surgery. “We are excited about these results,” McAneny says.

These findings were presented at the 2012 American College of Surgeons Annual Clinical Congress earlier this month, and hospitals around the country have already inquired about developing the program at their facilites. Not only does it help save lives, it also saves money.

“We have two campuses and are standardizing the care between the campuses,” McAneny says.  “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.”

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