TY - JOUR
T1 - The effect of respiratory therapist-initiated treatment protocols on patient outcomes and resource utilization
AU - Kollef, Marin H.
AU - Shapiro, Steven D.
AU - Clinkscale, Darnetta
AU - Cracchiolo, Lisa
AU - Clayton, Donna
AU - Wilner, Russ
AU - Hossin, Linda
N1 - Funding Information:
This investigation was supported by a grant provided by the American Association of Respiratory Care.
PY - 2000
Y1 - 2000
N2 - Context: Physicians frequently prescribe respiratory treatments to hospitalized patients, but the influence of such treatments on clinical outcomes is difficult to assess. Objective: To compare the clinical outcomes of patients receiving respiratory treatments managed by respiratory care practitioner (RCP)-directed treatment protocols or physician-directed orders. Design: A single center, quasi-randomized, clinical study. Setting: Three internal medicine firms from an urban teaching hospital. Patients: Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive respiratory treatments. Main outcome measures: Discordant respiratory care orders, respiratory care charges, hospital length of stay, and patient- specific complications. Discordant orders were defined as written orders for respiratory treatments that were not clinically indicated as well as orders omitting treatments that were clinically indicated according to protocol- based treatment algorithms. Results: Firm A patients (n = 239) received RCP- directed treatments and had a statistically lower rate of discordant respiratory care orders (24.3%) as compared with patients receiving physician-directed treatments in firms B (n = 205; 58.5%) and C (n = 250; 56.8%; p < 0.001). No statistically significant differences in patient complications were observed. The average number of respiratory treatments and respiratory care charges were statistically less for firm A patients (10.7 ± 13.7 treatments; $868 ± 1,519) as compared with patients in firms B (12.4 ± 12.7 treatments, $1,124 ± 1,339) and C (12.3 ± 13.4 treatments, $1,054 ± 1,346; p = 0.009 [treatments] and p < 0.001 [respiratory care charges]). Conclusions: Respiratory care managed by RCP-directed treatment protocols for non-ICU patients is safe and showed greater agreement with institutional treatment algorithms as compared with physician-directed respiratory care. Additionally, the overall utilization of respiratory treatments was significantly less among patients receiving RCP-directed respiratory care.
AB - Context: Physicians frequently prescribe respiratory treatments to hospitalized patients, but the influence of such treatments on clinical outcomes is difficult to assess. Objective: To compare the clinical outcomes of patients receiving respiratory treatments managed by respiratory care practitioner (RCP)-directed treatment protocols or physician-directed orders. Design: A single center, quasi-randomized, clinical study. Setting: Three internal medicine firms from an urban teaching hospital. Patients: Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive respiratory treatments. Main outcome measures: Discordant respiratory care orders, respiratory care charges, hospital length of stay, and patient- specific complications. Discordant orders were defined as written orders for respiratory treatments that were not clinically indicated as well as orders omitting treatments that were clinically indicated according to protocol- based treatment algorithms. Results: Firm A patients (n = 239) received RCP- directed treatments and had a statistically lower rate of discordant respiratory care orders (24.3%) as compared with patients receiving physician-directed treatments in firms B (n = 205; 58.5%) and C (n = 250; 56.8%; p < 0.001). No statistically significant differences in patient complications were observed. The average number of respiratory treatments and respiratory care charges were statistically less for firm A patients (10.7 ± 13.7 treatments; $868 ± 1,519) as compared with patients in firms B (12.4 ± 12.7 treatments, $1,124 ± 1,339) and C (12.3 ± 13.4 treatments, $1,054 ± 1,346; p = 0.009 [treatments] and p < 0.001 [respiratory care charges]). Conclusions: Respiratory care managed by RCP-directed treatment protocols for non-ICU patients is safe and showed greater agreement with institutional treatment algorithms as compared with physician-directed respiratory care. Additionally, the overall utilization of respiratory treatments was significantly less among patients receiving RCP-directed respiratory care.
KW - Asthma
KW - Chronic obstructive pulmonary disease
KW - Outcomes
KW - Protocols
KW - Respiratory care
UR - http://www.scopus.com/inward/record.url?scp=0033998576&partnerID=8YFLogxK
U2 - 10.1378/chest.117.2.467
DO - 10.1378/chest.117.2.467
M3 - Article
C2 - 10669692
AN - SCOPUS:0033998576
SN - 0012-3692
VL - 117
SP - 467
EP - 475
JO - CHEST
JF - CHEST
IS - 2
ER -