Sc. Body et al., Individualized feedback of volatile agent use reduces fresh gas flow rate,but fails to favorably affect agent choice, ANESTHESIOL, 90(4), 1999, pp. 1171-1175
Citations number
20
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Background Cost reduction has become an important fiscal aim of many hospit
als and anesthetic departments, despite its inherent Limitations. Volatile
anesthetic agents are some of the few drugs that are amenable to such treat
ment because fresh gas low rare (FGFR) can be independent of patient volati
le anesthetic agent requirement.
Methods: FGFR and drug use were recorded at the temporal midpoint of 2,031
general anesthetics during a 2-month preintervention period. Staff and resi
dents were provided with their preintervention individual mean FGFR, their
peer group mean, and educational material regarding volatile agent costs an
d low-flow anesthesia. FGFR and drug use were remeasured over a 2-month per
iod (postintervention) immediately after this information (N = 2,242) and a
gain 5 months later (delayed followup), for a further 2-month period (N = 2
,056).
Results: for all cases, FGFR decreased from 2.4 +/- 1.1 to 1.8 +/- 1.0 l/mi
n (26% reduction) after the intervention and increased to 1.9 +/- 1.1 l/min
(5% increase of preintervention FGFR) at the time of delayed follow-up. Us
e of more expensive volatile agents (desflurane and sevoflurane) increased
during the study period (P < 0.01), In a subgroup of 44 staff members with
more than five cases in all study periods, 42 members decreased their mean
FGFR after intervention. At delayed follow-up, 30 members had increased the
ir FGFR above postintervention FGFR but below their initial FGFR, After acc
ounting for other predictors of FGFR, the effectiveness of the intervention
was significantly reduced at follow-up (28% reduction), but retained a sig
nificant effect compared to preintervention FGFR (19% reduction).
Conclusions: Although individual feedback and education regarding volatile
agent use was effective at reducing FGFR, effectiveness was reduced without
continued feedback. Use of more expensive volatile agents was not reduced
by education regarding drug cost, and actually increased.