1996 OPEN FORUM Abstracts
Patient-Driven Protocols: Development and Implementation
Jan Phillips-Clar, BS, RRT Sunday, November 3, 1996
The current health care delivery environment mandates that hospitals and other providers of health care minimize cost, allocate resources based on medical necessity, and examine alternatives in the delivery of care that meet both fiscal and quality of care objectives. The changes necessitated by these mandates create new opportunities for respiratory practitioners to demonstrate their capabilities as providers of effective and efficient care. In January of 1993, as part of a hospital wide cost reduction strategy, the University of California San Diego (UCSD) Medical Center Respiratory Care Department implemented a protocol program designed to utilize the assessment skills and judgments of respiratory care staff, within physician approved guidelines. Patient Driven Protocols as we use them at UCSD are defined as: algorithmic paths that specify what care will be delivered, when care will be discontinued or altered, and when the physician will be contacted for change in management decisions. They contain locally agreed upon criteria for initiating care and discontinuing treatments and cover only those alterations in care that the local physicians agree should always occur when the protocol criteria are met. The protocols allow the RCP to initiate, alter and discontinue care without further physician order; but the RCP alters care based on objective findings specified in the protocols not based on individual judgment or therapeutic preference. PDPs were not designed to empower therapists to write orders, or serve as "pulmonary consults". They were designed to:
-Ensure that care that is supposed to be given will be given. -Allow adjustments in care with minor changes in patient condition without new physician orders. -Use the therapists as physician extenders. -Reduce physician and staff time spent getting orders changed or re-written. -Use therapist's skills to customize care based on individual patient responses. -Eliminate the need to document indications and criteria for discontinuing care for most patients.
The initial evaluation is performed within 24 hours of the service request. All of our staff, both technician and therapist level practitioners, perform evaluations, rather than a few specially trained evaluators. In the past three years the PDP program has continued to get results that exceeded our early expectations. A $700,000 (30%) reduction has been achieved in operating expenses of which we attribute most to PDPs. During a critical time in restructuring respiratory care, the PDP program shifted the focus that the real issue in re-engineering care delivery was not, who should do what, but is best suited to insure that only medically necessary care is provided.