PT  - JOURNAL ARTICLE
AU  - Fleming, Kellianne
AU  - George, Jessica L
AU  - Bazelak, Sarah J
AU  - Roeske, Julie A
AU  - Biggs, Adam D
AU  - Landry, Curtis M
AU  - Lipchik, Randolph J
AU  - Truwit, Jonathon D
TI  - Optimizing Respiratory Therapy Resources by De-Implementing Low-Value Care
AID  - 10.4187/respcare.10712
DP  - 2023 May 01
TA  - Respiratory Care
PG  - 559--564
VI  - 68
IP  - 5
4099  - http://rc.rcjournal.com/content/68/5/559.short
4100  - http://rc.rcjournal.com/content/68/5/559.full
AB  - BACKGROUND: Our institution was experiencing a respiratory therapy staffing crisis during the COVID-19 pandemic, in part due to excessive workload. We identified an opportunity to reduce burden by limiting use of 3% hypertonic saline and/or N-acetylcysteine nebulizer therapies (3%HTS/NAC).METHODS: Leveraging the science of de-implementation, we established a policy empowering respiratory therapists to discontinue 3%HTS/NAC not meeting the American Association for Respiratory Care (AARC) Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients. After a 3-month period of educating physicians and advanced practice practitioners the policy went to into effect. Outcomes measured included monthly number of treatments, orders, and full-time employees associated with administering nebulized 3%HTS/NAC.RESULTS: Post policy activation, the monthly mean 3%HTS/NAC treatments were significantly reduced to 547.5 ± 284.3 from 3,565.2 ± 596.4 (P < .001) as were the associated monthly mean of full-time employees, 0.8 ± 0.41 from 5.1 ± 0.86 (P < .001). The monthly mean 3%HTS/NAC orders also fell to 93.8 ± 31.5 from 370.0 ± 46.9 (P < .001). Monthly mean non-3%HTS/NAC treatments remained stable; post policy was 3,089.4 ± 611.4 and baseline 3,279.6 ± 695.0 (P = 1.0).CONCLUSIONS: Implementing a policy that empowers respiratory therapists to promote adherence to AARC Clinical Guidelines reduced low-value therapies, costs, and staffing needs.