title: Physician-ordered aerosol therapy versus respiratory therapist-driven aerosol protocol: the effect on resource utilization.
abstract: BACKGROUND
  The utilization of respiratory therapist (RT) driven protocols for single interventions, such as oxygen titration and bronchopulmonary hygiene, and protocols consisting of multiple interventions have been associated with improvements in resource utilization. Based on this, we started a quality improvement project to transition the delivery of respiratory care services from physician-ordered treatments to RT-driven protocols. During the first phase of our quality improvement project, we compared the frequency of bronchodilator administration and its associated costs, between a physician-ordered bronchodilator strategy and a RT-driven bronchodilator protocol strategy.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data obtained during the initial phase of a quality improvement project. Over a period of 2 weeks, RTs administered physician-ordered bronchodilator treatments. During this time they assessed the subjects' clinical status and what they would have recommended in regard to bronchodilator treatment frequency following an RT-driven protocol.
  
  
  RESULTS
  Forty-eight subjects were ordered bronchodilator treatments, which resulted in 88 assessments. The utilization of a protocol would have resulted in 42 (47.7%) bronchodilator orders administered "every 6 hours, as needed," and 27 (30.6%) orders administered "every 8 hours," compared with 2 (2.2%) and 2 (2.2%), respectively, in the physician-ordered group (P < .001). Conversely, physician-ordered treatments were prescribed "every 4 hours" in 56 (63.6%) cases, compared with 10 (11.3%) in the RT-driven protocol group (P < .001). Total bronchodilator therapy cost in the physician-ordered group was $1,672.85, whereas it would have been $904.53 in the RT-driven one. Per patient costs were $19.0 ± 6.9 in the physician-ordered group, and would have been $10.3 ± 9.4 in the RT-driven bronchodilator protocol group (P < .001).
  
  
  CONCLUSIONS
  The application of an RT-driven bronchodilator protocol can hypothetically reduce the frequency of bronchodilator treatments, compared with a physician-ordered strategy, resulting in a theoretical reduction of costs in patients who require bronchodilator therapy.
authors: Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska 68131, USA.
authors: Avyakta
authors: A
authors: Kallam
authors: Kathy
authors: K
authors: Meyerink
authors: Ariel M
authors: AM
authors: Modrykamien
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D006295:Health Resources; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012138:Respiratory Therapy / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014600:Utilization Review
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents