Ankit Dhamija1, Jahnavi Kakuturu1, Drew Schauble1, Heather K Hayanga2, Jeffrey P Jacobs3, Vinay Badhwar1, J W Awori Hayanga4. 1. Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia. 2. Division of Cardiac Anesthesia, Department of Anesthesia, West Virginia University, Morgantown, West Virginia. 3. Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia; Congenital Heart Center, Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida. 4. Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia. Electronic address: jeremiah.hayanga@wvumedicine.org.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a resource-intense modality of care whose use has grown exponentially. We examined volume and utilization trends to identify the financial break-even point that might serve to dichotomize between nurse specialist-led and perfusionist-led ECMO programs. METHODS: Data pertaining to patients who required ECMO support between 2018 and 2019 were reviewed. ECMO staffing costs were estimated based on national trends and modeled by annual utilization and case volume. A break-even point was derived from a comparison between nurse specialist-led and perfusionist-led models. For each scenario, direct medical costs were calculated based on utilization, which was in turn defined by "low" (4 days), "average" (10 days), and "high" (30 days) duration of time spent on ECMO. RESULTS: Within the study time frame, there was a total of 107 ECMO cases with a mean ECMO duration of 11 days. Overall, ECMO nursing personnel costs were less than those for perfusionists ($108,000 vs $175,000). Programmatic costs were higher in the perfusionist-led vs nurse specialist-led model when annual utilization was greater than 10 cases and ECMO duration was longer than a mean of 9.7 days. There was no difference in survival between the 2 models. CONCLUSIONS: Use of a perfusionist-led ECMO model may be more cost-conscious in the context of low utilization, smaller case volume and shorter ECMO duration. However, once annual case volume exceeds 10 and mean ECMO duration exceeds 10 days, the nurse specialist-led model may be more cost-conscious.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a resource-intense modality of care whose use has grown exponentially. We examined volume and utilization trends to identify the financial break-even point that might serve to dichotomize between nurse specialist-led and perfusionist-led ECMO programs. METHODS: Data pertaining to patients who required ECMO support between 2018 and 2019 were reviewed. ECMO staffing costs were estimated based on national trends and modeled by annual utilization and case volume. A break-even point was derived from a comparison between nurse specialist-led and perfusionist-led models. For each scenario, direct medical costs were calculated based on utilization, which was in turn defined by "low" (4 days), "average" (10 days), and "high" (30 days) duration of time spent on ECMO. RESULTS: Within the study time frame, there was a total of 107 ECMO cases with a mean ECMO duration of 11 days. Overall, ECMO nursing personnel costs were less than those for perfusionists ($108,000 vs $175,000). Programmatic costs were higher in the perfusionist-led vs nurse specialist-led model when annual utilization was greater than 10 cases and ECMO duration was longer than a mean of 9.7 days. There was no difference in survival between the 2 models. CONCLUSIONS: Use of a perfusionist-led ECMO model may be more cost-conscious in the context of low utilization, smaller case volume and shorter ECMO duration. However, once annual case volume exceeds 10 and mean ECMO duration exceeds 10 days, the nurse specialist-led model may be more cost-conscious.
Authors: Justyna Swol; Daniel Brodie; Anne Willers; Bishoy Zakhary; Joseph Belezzo; Zachary Shinar; Scott D Weingart; Jonathan W Haft; Roberto Lorusso; Giles J Peek Journal: Artif Organs Date: 2021-11-05 Impact factor: 2.663
Authors: James Lee West; Andrew Nutting; Brock Daughtry; Andrew M Frey; Clara T Nicolas; Rayan Saab; David H Sibley; Joshua Smith; Ronald Roan; Michael Crain Journal: J Card Surg Date: 2022-04-19 Impact factor: 1.778