The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

Pediatric Respiratory Driven Protocols: Appropriateness Of Therapy, Economic Savings And Patient Outcomes-T

Mitchell RRT, M Miller RRT, D Habib MD and G Silvestri MD, Medical University of South Carolina Children's Hospital, Charleston, South Carolina

Objective: To develop and implement a therapeutic and cost effective respiratory therapy protocol program for pediatric general floor and ICU patients. Materials and

Methods: Following a literature search and evaluation of Clinical Practice Guidelines, assessment criteria were established to determine the appropriateness of Pediatric Respiratory Care orders. Assessments were based on a rated scoring system for patient history, physical examination and documented indications. Four Registered Respiratory Therapists (RRT) participated in the data collection at our 148 bed facility. Interrater reliability and physician assessment inservicing was performed to document consistency and accuracy of the assessments. Pre-protocol data for 172 pediatric patients determined; 16 (18%) Hand held nebulizer (HHN) and 15 (22%) Chest physiotherapy (CPT) treatments were not indicated. The patient assessment program was presented to the pediatric physicians for hospital-wide implementation. Three hundred and ninety six patients were assessed over a two month period. Adverse patient outcomes were monitored through; 1. occurrence reports (documentation of adverse patient reactions), 2. increases in modality or frequency of Rx within 24 hours of a completed patient assessment and 3. variance reports (protocol documentation of disagreement in physician therapy ordered vs. therapist assessment). Economic savings were calculated based on patient charges, not cost. Labor estimates were derived from applying AARC timed work units to the number of nonindicated therapies. Interrater reliability was compared using Pearson correlation coefficient.

Results: Four hundred sixty six HHN and 870 CPT orders were evaluated. Protocol assessment resulted in a reduction of 140 (31%) HHN's (p < 0.05) and 182 (22%) CPT's (p < 0.05). The majority of nonindicated therapies were a result of frequency discrepancies (69%), not inappropriate modality (31%). Ten (.03%) orders for therapy resulted in an increased frequency. The approximate annual savings in patient charges would be $244,000.00. Of that total, $105,000.00 is attributable to labor costs (representing 3.4 full-time staffing equivalencies.) No adverse outcomes were noted. Three variance reports were submitted with the therapies administered as ordered. Assessments were highly reproducible between therapists (Pearson r=0.9). Conclusion: 1. Pediatric Respiratory Driven Protocols substantially decreased the frequency of procedures administered at our institution. 2. No adverse effects were noted when therapies were altered to meet protocol guidelines. 3. A major cost savings can be realized. 4. Pediatric Respiratory Driven Protocols for HHN/CPT can be effectively administered when a rigorous protocol is developed, trained assessors are utilized, physician input and education occurs and current practice guidelines are followed.


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