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Analysis: Hosp. Saves on Meds, Patients OK

Posted on: Thursday, 26 October 2006, 12:00 CDT

By ED SUSMAN

Researchers said they can save hospitals a bundle in time and money by reducing medication offered to in-hospital patients with chronic obstructive pulmonary disease (COPD) -- without causing harm to the patients.

Facing never-ending shortages in funds and staffing, Robert Pikarsky, administrative director for respiratory services at Crouse Hospital in Syracuse, N.Y., parlayed a new device and more effective therapy into a winning ticket.

When you work at a non-profit community hospital, you are always looking for ways of delivering good medicine for less cost, Pikarsky told United Press International Thursday at the annual meeting of the American College of Chest Physicians in Salt Lake City.

Pikarsky noted the time it took to deliver life-saving medications to patients hospitalized due to shortness of breath caused by lung disease, then focused on making the process less time-consuming for his staff and less expensive without compromising patient safety -- especially the procedure called nebulization.

Patients who need pharmaceuticals to counter their disease breathe in the drugs through a nebulizer, a device that converts liquid into tiny droplets so they can be easily inhaled into the lungs. These so-called bronchodilaters open up the lung passages, allowing for more air to be inhaled.

What Pikarsky needed was a more efficient drug than the standard albuterol, which is administered six times a day, and a more efficient nebulizer.

When he found both -- the better drug is levalburterol by Xopenex, the better device is the AeroEclipse Breath Actuated Nebulizer -- Pikarsky went to his hospital and proposed a two-month study.

He would divide a standard 3 milliliter dose of Xopenex into three 1 ml doses and administer it with the new, more efficient nebulizer three times a day. In essence, he would give patients one-half the treatments, in one-third the time, with one-third of the drug. Pikarsky also kept track of how often the revised drug regimen resulted in the need for more therapy in between the regular dosing schedule.

These so-called breakthrough bouts of shortness of breath would indicate how well patients were doing.

We demonstrated that we could save more than five minutes in time for each nebulization -- it took the respiratory specialists about eight minutes to deliver the standard 3 ml dose of Xopenex, but less than three minutes to deliver 1 ml, he noted. In two months that saved 99 hours of care that could be used in other areas of the hospital.

It also saved on the cost of the drugs. Using one-third the dose was a cash savings on an annual basis of $3,000. However, the AeroEclipse devices were more expensive, adding $10,000 to Pikarsy's yearly costs for the devices. The labor savings, however, when figured over a year, was more than $54,000. The bottom line: a potential yearly savings of $43,000.

But none of the savings was important if the patients suffered, he said. When they were given the older medicine, albuterol, for every 100 days of treatment there were 13.7 calls for additional medication.

When Pikarsky analyzed all the other dose regimens of Xopenex, albuterol as well as other agents, the breakthrough rate ranges from about 4.8 to 6.0 for every 100 days of treatment. The differences were not statistically significant between those agents, but were significant compared to albuterol.

What was different from my standpoint, Stephen Alkins, a pulmonary specialist who practices at Crouse Hospital, told UPI, "was that I wasn't getting those emergency calls at home in the middle of the night that my patients needed additional treatment.

This new nebulizer even with the lower dose appears to do the job, he said.

Pikarsky said the study was performed using hospital staff and funds and was not paid for by the pharmaceutical industry or the manufacturer of the device.

This was a two-month trial, cautioned Donald Tashkin, professor of medicine at the University of California, Los Angeles, who commented as he reviewed the poster presentation. We need to see if, in practice, the efficiency demonstrated in the trial can be carried forward. We also have to be sure that the reduction in medicine does not affect outcomes.

Source: United Press International

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