title: Implementation of a β-Agonist/Airway Clearance Protocol in a Pediatric ICU.
abstract: BACKGROUND
  Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for β-agonist and airway clearance interventions where one did not exist.
  
  
  METHODS
  This project was composed of 2 parts: a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven β-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure.
  
  
  RESULTS
  Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the β-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre- and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity (P= .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores (P= .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, β-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics (P< .001) for the therapist-driven protocol group.
  
  
  CONCLUSIONS
  In this institution, implementation of a β-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU.
authors.affiliation: Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas. lowegr@archildrens.org.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lowe
authors.affiliation: Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: J Randy
authors.initials: JR
authors.lastname: Willis
authors.affiliation: Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Shasha
authors.initials: S
authors.lastname: Bai
authors.affiliation: Critical Care Medicine Section, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas at the time of this study and is currently affiliated with the Spence and Becky Wilson Baptist Children's Hospital, Memphis, Tennessee.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Heulitt
mesh_terms: D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D007902:Length of Stay; D008297:Male; D012131:Respiratory Insufficiency / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: evidence-based medicine; quality improvement; respiratory care protocols; therapist-driven protocols