Abstract
BACKGROUND: A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or under-ordering (ie, therapy indicated but not ordered). The rate of agreement with RTCS-based orders is defined as the percentage of patients with no misallocation. This study was undertaken to compare current misallocation and agreement with historical benchmark rates at a hospital with an RTCS (ie, the Main Campus, or “on-MC”) and 2 hospitals that did not have an RTCS (ie, off-Main Campus, or “off-MC”).
METHODS: After approval by the institutional review board, data were collected during normal rounds. A respiratory therapist (RT) determined if the patient had an order for RTCS, what their treatments were, and whether treatment indications were present. RTCS treatments included aerosol therapy, bronchopulmonary hygiene, re-inflation, supplemental oxygen, oxygen monitoring, and suctioning. Agreement and misallocation were compared with chi-square or z-tests with P < .05 indicating significance.
RESULTS: The agreement rate for the RTCS on-MC was less than the benchmark rate established 20 years ago (63% vs 86%, P = .004), ascribed to misallocation of a single therapy, bronchopulmonary hygiene. The agreement rate with the RTCS on-MC was higher than that with off-MC RTCS (63% vs 33%, P < .001). Non-RTCS-based orders on-MC also had higher rates of agreement than orders with off-MC RTCS.
CONCLUSIONS: While the overall rate of agreement was lower with the RTCS currently than in the past, the decline seems solely attributable to a decline in the appropriateness of orders for bronchopulmonary hygiene. In addition, the rate of agreement for non-RTCS-based orders on-MC (71%), where the RTCS has been available for over 20 years, was higher than agreement rate for non-RTCS-based therapies off-MC (20%), where the RTCS has not yet been available. These findings suggest continued efficacy of the RTCS with the need for ongoing vigilance to assure optimal RTCS performance.
- respiratory care protocols
- respiratory therapy consult service
- misallocation
- licensed independent practitioner
Footnotes
- Correspondence: Robert L Chatburn MHHS RRT RRT-NPS FAARC, Department of Respiratory Therapy, Respiratory Institute, Cleveland Clinic, Mail Stop M-56, 9500 Euclid Ave., Cleveland, OH. E-mail: chatbur{at}ccf.org.
Mr Chatburn has disclosed relationships with IngMar Medical, imtmedical, and Drive-Devilbiss. The other authors have disclosed no conflicts of interest.
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