Chest
Volume 93, Issue 5, May 1988, Pages 1038-1042
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Clinical Investigations
Authoritative Medical Direction Can Assure Cost-Beneficial Bronchial Hygiene Therapy

https://doi.org/10.1378/chest.93.5.1038Get rights and content

A bronchial hygiene (BH) program for non-Intensive Care Unit (ICU) patients in which regimens are determined by respiratory therapy evaluators is described. The medical director of Respiratory Care was given control of orders by the medical staff and assumed responsibility for the evaluators' decisions. Patterns of BH utilization were analyzed for 24 months and were compared with BH utilization patterns in a preceding similar program in which orders were controlled by primary care physicians. Extra-ICU BH therapy (BHT) decreased by 61 percent and neither morbidity nor mortality was undesirably affected. Cost savings exceeded $250,000 per year. Authoritative medical direction of such a program results in cost-beneficial utilization of BHT, provides an excellent guide for resident physicians to learn appropriate utilization of such therapy, provides for quality assurance and medical necessity documentation, and is well accepted by the medical staff.

Section snippets

METHODS

This study was conducted by prospectively reviewing and tabulating all bronchial hygiene (BH) evaluations performed from September 1, 1985, through August 31, 1987. Comparisons were retrospectively tabulated with records of BH orders, evaluations and therapy administered from September 1, 1983, through August 31, 1984. To evaluate the impact of this program on the pattern of physician requests for BHT, comparisons were made between the first and second 12-month periods of the new program.

The BH

RESULTS

The medical staff, department chairmen and hospital administration approved this BH Evaluation Program in November 1984 and implementation occurred in July 1985. The process was functioning smoothly by September 1, 1985.

From September 1, 1985 through August 31, 1986, 1,795 evaluations were performed representing monthly ranges of 112 to 192 with an average of 150 per month: 75 percent resulted in respiratory therapy treatments; 16 percent resulted in patient self administration of IS supervised

DISCUSSION

Our seven-year history of documented attempts to limit administration of extra-ICU BHT to patients who may potentially benefit from such therapy reveals that only transient improvements can be accomplished without authoritative medical direction. This means that the hospital medical staff must be willing to delegate authority for determining the extra-ICU BHT orders to the medical director of respiratory care. This has been well accepted at NMH over the past two years by the vast majority of

ACKNOWLEDGMENTS

The authors wish to acknowledge the performance and dedication of Priscilla Goodwill, R.R.T., Rozlyn Caruso, R.R.T., Louise Keane, R.R.T., John Parson, R.R.T. and the respiratory therapist evaluators. The cooperation and confidence of the medical staff and administration of Northwestern Memorial Hospital are appreciated.

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