The effect of respiratory therapist-initiated treatment protocols on patient outcomes and resource utilization.
BACKGROUND
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.


METHODS
A single center, quasi-randomized, clinical study.


METHODS
Three internal medicine firms from an urban teaching hospital.


METHODS
Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive respiratory treatments.


METHODS
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.
Kollef
M H
MH
Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA. mkollef@pulmonary.wustl.edu
Shapiro
S D
SD
Clinkscale
D
D
Cracchiolo
L
L
Clayton
D
D
Wilner
R
R
Hossin
L
L
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008173:Lung Diseases, Obstructive / Q000191:economics / Q000534:rehabilitation*; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics*; D055656:Prescriptions / Q000191:economics; D012138:Respiratory Therapy / Q000191:economics*