Physician-ordered respiratory care vs physician-ordered use of a respiratory therapy consult service: early experience at The Cleveland Clinic Foundation.
BACKGROUND
Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation.


METHODS
The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients). In the pilot study, Therapist Evaluators responded to requests for Consults on two study wards. All staff therapists participated in implementing Evaluator-determined treatment.


METHODS
We evaluated 38 patients (20 of whom were Consult patients) randomly selected from a total of 82 patients undergoing abdominal surgery during the study period.


RESULTS
Consult patients were significantly older than non-Consult patients, more likely to be heavy smokers (67 vs 43%), and sicker as suggested by a higher Triage Score. Consult patients received more types and more total respiratory care services, demonstrated a trend toward longer stay, and had significantly higher respiratory therapy charges.


CONCLUSIONS
Our experience shows that a consult program can be successfully implemented in a large, tertiary care institution with widespread physician and nursing support. Whether the RTCS fulfills its goal of ameliorating misallocation of respiratory care has yet to be proven and awaits the completion of other studies currently under way.
Cleveland Clinic Foundation, OH 44195.
J K
JK
Stoller
D
D
Haney
J
J
Burkhart
L
L
Fergus
D
D
Giles
E
E
Hoisington
L
L
Kester
J
J
Komara
K
K
McCarthy
B
B
McCann
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000465:Algorithms; D003657:Decision Making; D005568:Forms and Records Control; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D017722:Hospital Charges / Q000706:statistics & numerical data; D006770:Hospitals, Group Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay / Q000706:statistics & numerical data; D009820:Ohio; D010347:Patient Care Planning / Q000592:standards*; D010865:Pilot Projects; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012139:Respiratory Therapy Department, Hospital / Q000706:statistics & numerical data*; D014218:Triage / Q000145:classification; D014600:Utilization Review / Q000458:organization & administration*