1995 OPEN FORUM Abstracts
Effect Of Clinical Guidelines In Reducing Unnecessary Respiratory Care In Non-Icu Patients
John Sestito,BA,RRT, Ponce Arrington,BA,RRT,Harold Palevsky,MD.,David Shulkin, M.D., Michael Santoro,BS,RRT,John Hansen-Flaschen, M.D. Lynda Gradwell, MS, RRT, University of Pennsylvania Medical Center.
INTRODUCTION: Efforts to contain unnecessary utilization of respiratory care modalities has become a major concern in recent years. As managed care continues to re-shape the market, cost-efficient as well as efficacious care will be key ingredients to the viability of health care facilities throughout the country. We identified several respiratory care modalities which historically have been overused at our institution. These respiratory care modalities includes: inhaled bronchodilator delivery (SVN=HHN,MDI), Chest Physical Therapy (CPT), and Oxygen Therapy.
Methods: Clinical guidelines were formulated for the modalities mentioned above by a multidisciplinary team which included nurses, physicians, and respiratory therapists. These guidelines were consisted with the guidelines established by the AARC for HHN,MDI,Oxygen therapy, and CPT. A randomized study was conducted on non-ICU patients evaluating the appropriateness of physician ordered HHN,MDI,oxygen therapy and CPT using the approved clinical guidelines. Evaluation of appropriateness included a physical assessment, and medical chart review. This evaluation was conducted prior to publishing and subsequent distribution of the clinical guidelines to the housestaff. After approximately 1 year of publishing the clinical guidelines, another randomized study using the same methodology was conducted.
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CONCLUSION: Clinical guldelines and education has generally failed to reduce unnecessary respiratory care at our institution. Although there has been some improvement in the utilization of CPT, inhaled medication delivery and oxygen therapy has shown little improvement. A consultative or evaluation program which examines the appropriateness of the above mentioned respiratory care modalities is the next strategy we will implement. Research has suggested that a consultative service, which incorporates clinical guidelines, has been successful in reducing unnecessary care and providing appropriate care to those patients in need. We will study the effects of this strategy in the next year.