1996 OPEN FORUM Abstracts
THE EFFECT OF A CONSULT SERVICE ON INAPPROPRIATE THERAPIES
J. Sestito. RRJ. P. Arrington. RRT. H. Santoro. P.R.T. H. Palevsky, M.D.D. Shulkin. M.D J. Hansen-Flaschen. M.D., D. Reily. RRT. University of Pennsylvania Medical Center. Philadelphia. Pa.
INTRODUCTION: We have been monitoring inappropriate ordering of respiratory care for the past four years. We have reported this phenomenon in several studies. Inappropriate orders fall under a variety of categories which include over utilization under utilization or ineffective prescribed therapy. Efforts to reduce inappropriate ordering and subsequent delivery of care included the following: establishment of respiratory therapy clinical guidelines by a multi-disciplinary team, approval of these guidelines by the institution's Medical Board, and education efforts coordinated by the respiratory care department. Education efforts included publication of these guidelines in the hospital policy and procedure book, and distribution of a respiratory care booklet which included all the established guidelines for appropriately ordering respiratory care. Distribution was targeted at interns, resident and attending physicians.
Methods: A consult service, consisting of a core group registered respiratory therapists was established. The concept of the service was approved by the hospital medical board. The consult service incorporated therapy guidelines previously approved. The consult service in essence would evaluate physician requests for therapy and make recommendations. The consult therapist received additional training in assessment workshops which included physician partnerships in an outpatient clinic setting and were incorporated in the Pulmonary physician consult service. This study compared the percent of inappropriate inhaled medication orders before and after implementation of the consult concept. Two hundred and sixty two (262) orders were studied pre-and one hundred and sixty eight orders (168) studied post-implementation.
pre consult Post consult P
262 orders 168 orders
79 inappropriate 18 inappropriate
30% rate 11% rate (P < 0.0003)
CONCLUSION: Implementation of a respiratory care consultation service improved compliance with clinical guidelines and significantly reduced the rate of inappropriate ordering of inhaled medication therapy. The consult service was significant in decreasing the rate of inappropriate ordering of inhaled medication therapy at our institution.