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Clinical InvestigationsAuthoritative Medical Direction Can Assure Cost-Beneficial Bronchial Hygiene Therapy
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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