1996 OPEN FORUM Abstracts
CHANGING PATTERNS AND COSTS OF PROVIDING RESPIRATORY CARE SERVICES ACCOMPANYING A RESPIRATORY THERAPY CONSULT SERVICE.
James K. Stoller, MD, Douglas Orens, MBA, RRT, Kevin McCarthy, RCPT, Lucy Kester, MBA, RRT, David Hancy, RRT, The Cleveland Clinic Foundation, Cleveland, Ohio.
Background: As therapist-driven protocol programs become more prevalent, there is a continued need to evaluate their impact and effectiveness. Recent experience suggests that use of respiratory care protocols can enhance the allocation of respiratory care services. By reducing "over-ordering", defined as prescribing services unlikely to provide benefit, cost savings are expected and have been demonstrated in recent studies. As part of our ongoing analysis of respiratory care services at the Cleveland Clinic Foundation, we re viewed the differences in volume and costs of providing respiratory care services over a five year period starting in 1991 and ending in 1995. Methods: The Respiratory Therapy Consult Service (RTCS) was first implemented for hospital-wide use at physician discretion in February 1992 and was mandated for most non-ICU adult inpatient care in August 1994. Using true variable and fixed costs for providing respiratory care services and a management information system that tallies all respiratory care services delivered, we calculated the volume and costs associated with the five highest volume adult non-ICU respiratory care services at the Cleveland Clinic Hospital: aerosol medication delivery (SVN), metered dose inhalers (MDI), oxygen therapy, bronchopulmonary hygiene (BPH), and incentive spirometry. To assess the impact of the RTCS on volume and costs of respiratory care services, 1991 data (before RTCS) were compared with 1995 data (RTCS supervised most of the non-ICU adult inpatient care delivered). Results: Despite a stable hospital census between 1991 (16,989 patients) and 1995 (16,997 patients), the total number of these five therapies administered (202,728 in 1991 to 169,097 in 1995). The accompanying decrease in cost for these services was $327,353 over this interval. The average cost per patient for providing the five therapies was reduced from $93.98 in 1991 to $74.68 in 1995. Most of the saving was associated with a decline in the volume of time-consuming services (i.e., SVN and BPH) by 38,594 treatments, producing a cost decrease of $304,466 Delivery of acrosolized bronchodilators (SVN, MDI) increased by 2,903 treatments. Notably, this was offset by the increase of the proportion of bronchodilator therapics administered by MDIs (less costly than SVNs). from 25% of all bronchodilators (22,513) in 1991 to 44% (41,300) in 1995, resulting in a cost decrease of $37,655. Oxygen therapy was reduced by 10,356 patient-days over the five year period, resulting in a cost savings of $101,489. Conclusions: We conclude 1: Between 1991 and 1995, changing patterns of use for the highest volume respiratory care services delivered to non-ICU adult inpatients was associated with a substantial decrease in the number of therapies and associated costs. 2. Implementation of the Respiratory Therapy Consult Service during this interval effected a cost savings by encouraging the use of effective but less expensive respiratory care modalities (e.g., MDIs vs SVNs).