At a nickel per patient visit, AEDs are a good investment
At a nickel per patient visit, AEDs are a good investment
Despite advantages, only a handful of hospitals use these lifesavers
Preliminary data show that placing automated external defibrillators (AEDs) throughout your hospital is a low-cost way to save lives. The units have come down in price from a couple of years ago but are still expensive when you’re talking large quantities. The new units run between $2,500 and $4,000, depending upon the bells and whistles you choose. But even when that capital outlay is taken into consideration, saving a life can cost pennies five to be exact.
What nurses typically do in the face of cardiac arrest is start basic CPR, call for a Code Blue team from another part of the hospital, and then wait. The team can take from one to eight minutes to get there, after which the patient is hooked up to the machine, and the team interprets the rhythm and administers the shocks. For each minute ventricular fibrillation persists, the likelihood of successful resuscitation decreases by about 10%, and after 10 minutes, few attempts succeed.1 For patients who survive, the longer they wait for defibrillation, the more damage their hearts sustain, resulting in longer and more expensive ongoing care. Inadequate access to quick defibrillation can also impact your liability and expose your facility to malpractice risk. (See story on risk management and AEDs, p. 74.)
"If it takes the Code Blue team several minutes to get there," explains Les Wooldridge, RN, educational coordinator of the Resuscitation Program at Vanderbilt University Medical Center in Nashville, TN, "and if 10% survival is lost for every minute that passes, the patient’s chances are diminished significantly."
The American Heart Association (AHA) in Dallas believes early defibrillation is the single most important lifesaving maneuver in the "cardiac chain of survival" the sequence of events that also includes early access to emergency services, early basic CPR, and early advanced life support. While most important, defibrillation is often the weakest link in the chain. (See story on the quality of life following CA, p. 73.)
Mary Ann Peberdy, MD, a cardiologist at Medical College of Virginia (MCV) Hospitals in Richmond, set out to analyze the cost-effectiveness of placing AEDs throughout the ambulatory areas of a hospital. She and her research team presented their findings at the Public Access to Defibrillation conference held in Arlington, VA, in April. To determine how much AEDs cost per patient visit, the team looked at a large multispecialty setting where physicians are not available continuously and where the staff had little or no training in even basic CPR.
Peberdy’s team developed a mathematical research model that added the initial cost of a defibrillation unit to the cost of its maintenance over 10 years. The team added to that total the cost of training inexperienced staff and divided the result by the number of patient visits over the 10-year period.
"We began by evaluating the response system to treat cardiac arrest," says Peberdy. "The first response tier consisted of 30 on-site nurses trained to provide first aid, CPR, and early defibrillation using 28 AEDs positioned strategically throughout the facility." The abstract Peberdy’s team presented stated that the research site treated 323,867 patients during 1996. The combined cost for AEDs, beepers, and training was $181,290. The team concluded that utilizing the devices cost a nickel per patient visit. "That’s a conservative estimate," adds Peberdy, "since the response system also protects all of the facility’s workers and visitors."
Carol Crosby, RN, MSN, nursing coordinator of ambulatory care at the MCV Hospitals says, "We now have AEDs alongside other emergency equipment on each floor of all the ambulatory care buildings on the main campus, and we’re moving the devices to satellite ambulatory care clinics around Richmond. We’re in the process of training staff in the use of AEDs along with basic life support training." The facility includes a 1,000-bed hospital and typically takes care of 500,000 ambulatory care visits a year in the private- and hospital-based clinics.
Cost Management in Cardiac Care asked Crosby how long it takes a typical staffer to learn how to use the AED. "Basic life support training usually takes about eight hours," she says, "and the AED component adds two to four hours to that."
But throughout a hospital?
Cathy Boze, RN, MSN, an advance practice nurse and educational consultant in the department of education and professional development at MCV Hospitals, trained the staff to use the equipment for the cost-effectiveness project there. "To take part in the project," she says, "nurses as well as non-nursing providers had to perform defibrillation, and they hadn’t been able to do that before this project. Our nursing staff comprises well over a thousand people. All those nurses now have a new skill with the potential to save lives. That’s where the excitement is. We now have the opportunity to help the people we’ve missed in the past."
The data the research team gathered related to an ambulatory setting. Only time will tell how cost-effective having these units throughout a hospital will be. The data aren’t in yet on that, but intuitively, investigators involved in the project say they know it’s a good idea. A hospital can buy four AEDs for every monitor defibrillator.
"Now that we’ve begun with research in the ambulatory setting," continues Boze, "it’s time to focus on providing access to AEDs throughout the hospital." Shock advisory defibrillation is common throughout the inpatient setting devices that analyze the heart rhythm like the AED.
But rather than administering a shock, it then advises the operator when to charge and shock. Standard monitor defibrillators are large upright units, about the size of three shoeboxes and weigh about 40 pounds. They cost between $6,000 and $10,000. The units don’t have the safety features of AEDs and require some clinical judgment on the part of the operator. Wooldridge advocates placing AEDs throughout a hospital.
AEDs really make a difference
"In 20 years of working in resuscitation, this is the most important factor I’ve seen for saving lives. Of all the things we’ve learned of all the new technologies this is one that really makes a difference. AEDs placed throughout a hospital," Wooldridge says, "would increase patients’ survival chance dramatically. The devices are user-friendly and make the process of shocking the patient simpler. They tell the operator what to do and when. If AEDs are placed throughout the hospital, help can be called for and, while it’s on the way, defibrillation can be initiated. There’s definitely a place for AEDs in the hospital. Eventually, as we begin to trust these units and realize how simple they are, many hospitals will start using them."
There are 80 large monitor defibrillators sitting on fully stocked emergency carts spread throughout several buildings of Vanderbilt’s 575-bed medical center. Wooldridge continues, "Most nursing staff, with the exception of those in cardiology, intensive care, or step-down units, are not trained to interpret the ventricular fibrillation as it comes across the screen." According to Wooldridge, nurses without a lot of experience would have difficulty using the advisory units. They have to hook cables to them, turn them on, and charge them all in an emergency setting.
"Shocking the patient safely and effectively takes practice," he says. "But not only that, it also takes courage born from experience. In that charged setting, the operator has to grab the paddles, apply them to the patient’s chest, call All clear,’ then shock the patient back to life. Those are not skills you would expect noncritical care providers to have."
Reference
1. Eisenberg MS, Horwood BT, Cummins RO, et al. Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 1990; 19:179-186.
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