Financial Impact of Incentive Spirometry.

Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to $240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to $136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95% confidence interval [CI], $97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be $1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable.

A prevalence study of methicillin-resistant Staphylococcus aureus colonization in emergency department health care workers.

STUDY OBJECTIVE: Few studies of the prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) in emergency department (ED) health care workers have been conducted. To better understand the epidemiology of this pathogen, we seek to determine the MRSA nasal colonization rates in the ED health care workers in our hospital. METHODS: We conducted a prospective cohort study on a convenience sample of ED health care workers, including nurses, physicians, and technicians. Nasal swabs from subjects were analyzed with a polymerase chain reaction assay for the presence of MRSA. RESULTS: Of the 105 ED health care workers enrolled, a total of 16 (15%, 95% confidence interval 9.6% to 23%) were MRSA positive. No significant difference was observed in colonization rates between nurses, physicians, and technicians. CONCLUSION: Our ED health care workers demonstrated a high prevalence of nasal MRSA colonization compared with individuals in recent community surveillance and other studies involving ED staff.

Perspectives on Incentive Spirometry Utility and Patient Protocols.

BACKGROUND: Incentive spirometry (IS) is widely used to prevent postoperative pulmonary complications, despite limited clinical effectiveness data and a lack of standardized use protocols. We sought to evaluate health care professionals' perspectives on IS effectiveness and use procedures. METHODS: An online survey was distributed via social media and newsletters to relevant national nursing and respiratory care societies. Attitudes concerning IS were compared between the American Association for Respiratory Care (AARC) and the nursing societies. RESULTS: A total of 1,681 responses (83.8% completion rate) were received. The clear majority of these respondents agreed that IS is essential to patient care (92.7%), improves pulmonary function (92.0%), improves inspiratory capacity (93.0%), helps to prevent (96.6%) and to reverse (90.0%) atelectasis, helps to prevent (92.5%) and to reverse (68.4%) pneumonia, and is as effective as early ambulation (74.0%), deep-breathing exercises (88.2%), and directed coughing (79.8%). Furthermore, most health care professionals believed that IS should be used routinely preoperatively (78.1%) and postoperatively (91.1%), used every hour (59.8%), used for an average of 9.6 (95% CI 9.3-9.9) breaths per session, used to achieve breath holds of 7.8 (95% CI 7.4-8.2) s, used to reach an initial target inspiratory volume of 1,288.5 (95% CI 1,253.8-1,323.2) mL, and used to achieve a daily inspiratory volume improvement of 525.6 (95% CI 489.8-561.4) mL. Of all respondents, 89.6% believed they received adequate IS education and training. Respondents from the AARC endorsed significantly less agreement relative to the nursing societies on most parameters for IS utility. CONCLUSIONS: There was a major discrepancy between health care professionals' beliefs and the published clinical effectiveness data supporting IS. Despite reported adequate education on IS, variability in what health care professionals believed to be appropriate use underscores the literature's lack of standardization and evidence for specific use procedures.

Incentive Spirometry Adherence: A National Survey of Provider Perspectives.

BACKGROUND: Patient adherence is a critical factor for success of patient-administered therapies, including incentive spirometry (IS). Patient adherence with IS is not known, so we sought to evaluate providers' perspectives on the current state of IS adherence and elucidate possible factors hindering patient adherence. METHODS: Respiratory therapists (RTs) and nurses across the United States were surveyed via social media and online newsletters. Surveys were distributed to the relevant national RT and nursing societies: the American Association for Respiratory Care, the Academy of Medical-Surgical Nurses, the American Society of Peri-Anesthesia Nurses, and the American Association of Critical-Care Nurses. RESULTS: Responses from 1,681 (83.8% completion rate) RTs and nurses were received. The clear majority of all providers agreed that patient adherence is poor (86.0%; 1,416 of 1,647 respondents) and should be improved (95.4%; 1,551 of 1,626 respondents). Providers believe that IS adherence is hindered by various factors. The most common reasons cited were that patients forget to use their ISs (83.5%; 1,404 of 1,681 respondents), do not use them effectively (74.4%; 1,251 of 1,681 respondents), and do not use them frequently enough (70.7%; 1,188 of 1,681 respondents). CONCLUSIONS: These findings from a large national survey of health care providers highlight the need for improved IS adherence and indicate that patient forgetfulness may be a large contributor to nonadherence. Efforts aimed at improving IS adherence are warranted.

The prevalence of methicillin-resistant Staphylococcus aureus colonization in emergency department fast track patients.

BACKGROUND: Over the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has evolved from a hospital-associated infection to a significant public health threat in the community, causing outbreaks of soft tissue infections in otherwise healthy individuals. The goal of this study was to determine the prevalence of nasal MRSA colonization in low acuity Emergency Department (ED) Fast Track patients in order to better characterize the epidemiology of this pathogen. METHODS: We conducted a cross-sectional study of a convenience sample of adult patients from our ED Fast Track. Nasal swabs were analyzed for MRSA using a polymerase chain reaction assay. Study participants completed a survey assessing traditional risk factors for CA-MRSA colonization. RESULTS: A total of 106 ED Fast Track patients were tested. Four (3.8%, 95% CI 1.5%-9.3%) were MRSA positive. Three traditional CA-MRSA risk factors (personal history of abscess, family history of abscess, and participation in contact sports) were examined. In patients with a positive MRSA nasal swab, only a personal prior history of abscess retained signifi cance (OR 33, 95% CI 1.7-676, P=0.02). CONCLUSION: This study found a higher prevalence of nasal MRSA colonization in low acuity ED Fast Track patients compared with historical community surveillance studies. A personal history of prior abscess was a signifi cant risk for CA-MRSA carriage.

The prevalence of methicillin-resistant Staphylococcus aureus colonization in emergency department fast track patients / 世界急诊医学杂志（英文）

@#BACKGROUND: Over the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has evolved from a hospital-associated infection to a significant public health threat in the community, causing outbreaks of soft tissue infections in otherwise healthy individuals. The goal of this study was to determine the prevalence of nasal MRSA colonization in low acuity Emergency Department (ED) Fast Track patients in order to better characterize the epidemiology of this pathogen. METHODS: We conducted a cross-sectional study of a convenience sample of adult patients from our ED Fast Track. Nasal swabs were analyzed for MRSA using a polymerase chain reaction assay. Study participants completed a survey assessing traditional risk factors for CA-MRSA colonization. RESULTS: A total of 106 ED Fast Track patients were tested. Four (3.8%, 95% CI 1.5%–9.3%) were MRSA positive. Three traditional CA-MRSA risk factors (personal history of abscess, family history of abscess, and participation in contact sports) were examined. In patients with a positive MRSA nasal swab, only a personal prior history of abscess retained significance (OR 33, 95% CI 1.7–676, P=0.02). CONCLUSION: This study found a higher prevalence of nasal MRSA colonization in low acuity ED Fast Track patients compared with historical community surveillance studies. A personal history of prior abscess was a significant risk for CA-MRSA carriage.