Leveraging Capnography to Standardize Care and Achieve Results

Capnography monitoring technology has traditionally been used in high-risk settings such as the operating room and ICU to monitor patient breathing for respiratory compromise. But now, healthcare providers are finding new uses for capnography technology that may improve both clinical outcomes for post-operative patients on the general care floorⁱ and procedure sedation suites^ii,iii,iv, and as a result, may experience improved safety and financial outcomes^v for their hospital systems.

Clinicians have historically relied on a combination of vital signs, oxygen levels and other clinical assessments to evaluate a patient's respiratory status after surgery. However, these measurements have limitations^vi. Measurements of ventilation like capnography, for example, on the other hand, have recently been championed by authoritative bodies like the Anesthesia Patient Safety Foundation to provide better, more standardized care that helps clinicians catch and address respiratory depression in post-operative patients receiving opioids^vii.

Pain management is one reason for increased focus in this area. As a result of pain management's correlation with patient satisfaction scores, healthcare is seeing more active management of post-operative patients on pain medication^viii. Relaxation of the patient's respiratory system, especially with opioid medications, is a common side effect.

Hospitals are experiencing better clinical outcomes as a result of expanding capnography usage. One hospital system in Savannah, Ga., had three incidences of respiratory arrest in one year that led to patient deaths^ix. After that, they acquired capnography technology, put in place protocols, and trained their staff. They haven't had a respiratory compromising event since^x.

The hospital experienced financial results, too. Their hospital CFO was a co-author of a study showing that after 5 years of implementing the technology, the hospital saved roughly $2 million in operating costs^xi. Why? It costs a health system, on average, $18,000 per patient that experiences some level of respiratory compromise^xii. And the burden is high: based on published literature, up to 7% of Medicare patients experience some type of respiratory compromise incident^xiii.

At Medtronic, we pledge commitments to shared outcomes, both clinical and financial, like Respiratory Compromise. We know that healthcare executives want to remove the clinical and financial variability that they see across their systems, and standardize to best practices. We see it as our shared mission to help our customers standardize to evidence based best practices and achieve the clinical outcomes they're wanting, while also reducing the cost.

About the Author: Kendall Qualls is the Vice President, Marketing for Respiratory Monitoring Solutions at Medtronic. Kendall has 20+ years of experience in the healthcare industry with leading sales and marketing teams at biopharmaceutical and medical device companies. Kendall was a member of the Board of Trustees at Nyack Hospital from 2011-2013 (member of the NY Presbyterian Hospital System). Before entering the healthcare industry, Kendall served as an officer in the U.S. Army, Field Artillery. He was stationed in the U.S. and in South Korea and received an honorable discharge. Kendall holds an MBA from the University of Michigan, Ross School of Business, M.A. Degree from the University of Oklahoma and a B.S. Degree from Cameron University.

ⁱ Kodali, B. Capnography outside the operating rooms. Anesthesiology. 2013; 118(1):192-200.

ⁱⁱ Beitz A, Riphaus A, Meining A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107(8):1205-1212.

ⁱⁱⁱ Qadeer MA, Vargo JJ, Dumot JA, et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136(5):1568-1576; quiz 1819-1520.

^iv Friedrich-Rust M, Welte M, Welte C, et al. Capnographic monitoring of propofol-based sedation during colonoscopy. Endoscopy. 2014;46(3):236-244.

^v Saunders, R, Erslon, M, Vargo, J. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy. Endoscopy International 2016; 04:E340-E351.

^vi Jensen, D et al. Capnographic monitoring can decrease respiratory compromise and arrest in post-operative surgical patients. Viewed at http://respiratorytherapy.ca/pdf/RT-11-2-Spring-2016-R21-POST.pdf.

^vii Stoelting, R and Overdyk, F. Essential Monitoring Strategies to Detect Clinically Significant Drug- Induced Respiratory Depression in the Postoperative Period. Viewed at http://www.apsf.org/announcements.php?id=7.

^viii Glowacki, D. Effective pain management and improvements in patients' outcomes and satisfaction. Critical Care Nurse Vol. 35, No. 3, June 2015. Viewed online at http://www.aacn.org/wd/Cetests/media/C1533.pdf.

^ix Maddox R, Williams C. Clinical Experience with Capnography Monitoring for PCA Patients. APSF Newsletter 2012:47-50.

^x Interview with Harold Oglesby. 8 Years of Event-Free PCA Monitoring. RT Magazine, 2012. Viewed online at http://www.rtmagazine.com/2012/12/8-years-of-of-event-free-pca-monitoring-2/.

^xi Danello SH, Maddox RR, Schaack GJ. Intravenous infusion safety technology: return on investment. Hospital Pharmacy 2009; 44:(8)680–687, 696.

^xii Kelley SD, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012;40(12):764.

^xiii Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract presented at Academy Health Congress, June 2011.