Chest
Clinical Investigations: Respiratory CarePhysician-Ordered Respiratory Care vs Physician-Ordered Use of a Respiratory Therapy Consult Service: Results of a Prospective Observational Study
Section snippets
MATERIALS AND METHODS
The design of the RTCS and the structure of the triage score have been described previously.12, 13 Briefly, major elements of RTCS include the following: (1) a team of therapist evaluators, who see consult patients in a timely fashion and generate respiratory care plans based on algorithms that have been published previously and that comply with available clinical practice guidelines of the American Association for Respiratory Care (AARC);14, 15, 16, 17 (2) a team of implementing therapists,
RESULTS
Ninety-eight patients were studied as a convenience sample. Over the 19-month study period, approximately 23,209 non-ICU adult inpatients were ordered to receive respiratory therapy at the Cleveland Clinic Foundation. Table 1 compares the demographic and clinical features of the two patient groups: those ordered by the physicians to receive respiratory care prescribed by the RTCS (n=51) vs those receiving respiratory care prescribed by the physicians themselves (nonconsult) (n=47). For
DISCUSSION
There are several main findings in this study.
- (1)
Use of a physician-ordered RTCS was associated with fewer misallocated initial respiratory care orders than when physicians prescribed respiratory care treatment themselves. By design, orders were considered misallocated or discordant when they deviated significantly from a standardized reference respiratory care plan that was based on AARC clinical practice guidelines for respiratory care treatment. Furthermore, in a multivariate analysis,
ACKNOWLEDGMENT
In appreciation for collaboration in completing this study, the authors wish to thank Larry Fergus, RN, MBA, RRT, Rebecca Meredith, RRT, Doug Orens, MBA, RRT, Beth Dobish, and the Section of Respiratory Therapy, Cleveland Clinic Foundation.
References (22)
- et al.
Uses and misuses of oxygen in hospitalized patients
Am J Med
(1992) - et al.
Medical personnel's knowledge of and ability to use inhaling devices: metered dose inhalers, spacing chambers, and breath-actuated dry powder inhalers
Chest
(1994) - et al.
Authoritative medical direction can assure cost-beneficial bronchial hygiene therapy
Chest
(1988) Misallocation of respiratory care services: time for a change [editorial]
Respir Care
(1993)- et al.
Ordering respiratory care services for hospitalized patients: practices of overuse and underuse
Cleve Clin J Med
(1992) - et al.
The effect of guidelines on appropriate use of arterial blood gas analysis in the intensive care unit
Respir Care
(1989) - et al.
The effects of therapist-evaluation of orders and interaction with physicians on the appropriateness of respiratory care
Respir Care
(1989) - et al.
Effect of reductions in respiratory therapy on patient outcome
N Engl J Med
(1986) - et al.
Early experience with the Respiratory Therapy Consult Service at the Cleveland Clinic Foundation [abstract]
Respir Care
(1992) - et al.
Benefits associated with a respiratory care assessment-treatment program: results of a pilot study
Respir Care
(1994)
Therapist-driven protocols: state-of-the-art
Respir Care
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Supported in part by an educational grant from Nellcor Puritan-Bennett Corporation, Carlsbad, Calif.