Incentive Spirometry

Incentive Spirometry

–Effective Tool or Unneeded Cost?

By Henry Owens, BS, RRT

As health care budgets continue to shrink, providers are constantly being asked to “do more with less.” And, as we’re all aware, respiratory care has not been spared the downside of budget cuts and staff reductions.

This is not to say our patients expect any less from us. Every patient enters a health care facility expecting the best we can offer in terms of staff, equipment and attention. Unfortunately, managed care, staff cuts, and outdated equipment are making it increasingly difficult to provide the best care possible. But there are certain inexpensive and relatively simple procedures, like incentive spirometry, that we can continue to provide post-operatively to patients to help ensure them as short a hospital stay as possible.

For a century now, caregivers have been instructed that post-operative patients must turn, cough and deep breathe regularly to ensure as quick a recovery as possible. Studies have proven that post-operative atelectasis–often the result of rapid, shallow breathing due to intense pain–can be a major contributor to post-operative morbidity. However, we can also agree that most post-operative patients, often medicated and disoriented, are not always willing or able to take the deep breaths necessary to prevent atelectasis or pneumonia.

Incentive spirometry (IS) is one of the more effective, yet simple and inexpensive tools available to assure that patients meet their prescribed breathing regimen. Unfortunately, the purpose of incentive spirometry seems to be misunderstood in many institutions.

On the surface, it seems that a device that only “encourages” a patient to breathe could not possibly be cost-effective, so in some cases incentive spirometry has fallen victim to the budget ax.

However, I see an obvious need for a cost-effective device that not only encourages the patient to reach a prescribed inspiratory goal, but also objectively assesses the degree and rate of inspiration. A volumetric incentive spirometer, with a patient goal indicator, can provide the caregiver and patient with a visible inspiratory goal and instantaneous assessment of inspiratory capacity and therapeutic flow rate.

I’m familiar with one hospital that has entirely reworked its post-operative care plan for cardiothoracic surgery patients. Prior to the new plan, there were an average of four returns per month to the ICU for all etiologies. The care team believed it could reduce this number by at least one return per month by adopting the plan.

The new plan is progressive, involves the entire health care team and affects almost every aspect of patient care, including patient education. Patient education begins during the pre-admission process and continues beyond discharge. Included is an emphasis on incentive spirometry to ensure post-operative respiratory health.

Formerly, all post-op patients received chest physiotherapy (CPT) as well as incentive spirometry every four hours. This was highly labor intensive and, therefore, costly. In addition, surveys taken at discharge documented patients did not use their incentive spirometer if it was simply issued without instruction on admission.

Now each patient receives pre-operative spirometry instruction from a trained nurse or respiratory care practitioner. Post-operatively, the patients self-administer incentive spirometry until their respiratory health is no longer a concern or they are discharged.

A respiratory care practitioner assesses the patient every 4 hours for the first 24 hours post-op, since it is felt that the first 24 hours are most critical to a successful transition from hospital to home. If certain parameters have been met, the patient is allowed to continue incentive spirometry at home. If the parameters haven’t been met, the respiratory care team becomes involved.

During the first six months the new plan has been in effect, the projected decease in ICU returns has been realized. It is estimated this reduced rate of ICU returns could equal $12,000 to $15,000 per month in savings to the institution–a potential yearly savings of $180,000. This money can be used to fund capital projects, hire additional staff or reduce operating budgets.

Some of the savings outlined above have been attributed to the intelligent and disciplined use of incentive spirometry, a cost-effective practice that involves a $4 device and no increase in labor. In this case study, the therapeutic and cost-saving benefits of incentive spirometry have been realized, and incentive spirometry will continue to be an integral part of the post-operative recovery process.

Henry Owens, BS, RRT, is an adjunct faculty member at Genesee Community College, Rochester, N.Y., and former assistant director of respiratory care at the University of Rochester Medical Center.

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