Financial Impact of a Pediatric NIV Mask Sizing Guide

Abstract

Background:

Finding appropriate fitting pediatric noninvasive ventilation masks (NIVM) is often a challenge. Secondary to this difficulty, our pediatric institution employs multiple options (20 NIVM) to allow for appropriate fit and comfort when providing NIV to patients. Many NIVM packages obscure the specifications of the mask, making opening of an inappropriate size NIVM a common risk. We aimed to evaluate the effects of a pediatric NIVM sizing guide by comparing the total cost of NIVM used and NIV billable days pre and post implementation.

Methods:

We created a NIVM sizing guide and provided staff education in April 2021. The sizing guide included photocopies of mask interfaces that were disposable and single use in a binder placed in each unit where NIV services occurred. An IRB-exempt retrospective data analysis was completed and included NIVM total cost and total NIV billable days pre (4/1/2020-3/31/2021) and post (4/1/2021-3/31/2022) implementation of the NIVM sizing guide.

Results:

Pre NIVM guide, the cost spent on NIVM was $124,392.31 with 2,133 billable NIV days. Post NIVM guide, the cost spent on NIVM $109,186.80 (12% decrease) with 3,917 billable NIV days (83.7% increase) (Graph 1). Mask cost per billed day decreased from $58.32 to $27.88 (71% decrease) after implementation of a NIVM sizing tool. A Levene one-way analysis of variance (ANOVA) test based on per day total by BPAP mask unit cost indicated a significant difference before the intervention [F (36, 644) = 31.93, P < .001].

Conclusions:

The development and use of an organization specific pediatric NIVM sizing guide resulted in a notable decrease in waste of NIVM. This relationship occurred despite an overall increase in NIV in the post-implementation period. This suggests that the use of a NIVM size guide could benefit other institutions in decreasing wasteful use of NIVMs by respiratory therapists who may initially choose the wrong size/fit mask. Other studies should be completed to evaluate the NIVM size guide’s clinical impact.