1996 OPEN FORUM Abstracts
Managing the Patient-Driven Protocols Program Using an Information System
Richard M. Ford, BS, RRT Sunday, November 3, 1996
In the past 2 years Respiratory Care Management Information Systems (RCMIS) have also incorporated the technology of wireless point of care documentation in which portable hand held computers, carried by respiratory practitioners, provides for clinical documentation at the bedside and transmission of data to a central department database. The real cost savings potential of acquiring such systems is in facilitating Patient Driven Protocols (PDPs). PDPs are driven by patient specific information and observations and required that we collect, store, process, and retrieve large amounts of patient data. To provide protocol driven therapy to the 100-150 patients we had on service each day, it was essential that mechanisms be in place to identify evaluations and treatments due, track indications for therapy, monitor patient response to therapy, investigate RCP compliance with the protocol care plan, trend transitions to alternative therapy, identify patient outcomes, and quantifying the impact of PDPs on department operations. Accomplishing the surveillance objectives of the protocol program could effectively be facilitated through either the hiring of additional staff, or through the acquisition of an RCMIS. At UCSD, all RCPs serve as evaluators and a hospital wide program is managed by a single Coordinator as a result of the centralized clinical surveylance capabilities of the system. We demonstrated the utility of the RCMIS in providing data to drive, monitor, assess, and report results of the PDP program. The system proved to be the "enabler" of the PDP program. As the utilization of RC services decreased so to did the cost associated with providing such service. The system was not justified for purchased based on the ability to reduce lost charges, to enhance revenue capture, or even its stated ability to improve productivity. Although all these factors contribute to enhancing the bottom line, the real cost savings potential of acquiring the system was its utility in facilitating Patient Driven Protocols which contributed to achieving a $700,000 reduction in cost the first year. Although key to enabling the PDP program at UCSD, clinical information systems will soon better support decision making. Over the past six months, in collaboration with Nellcor-Puritan Bennett, UCSD Respiratory Care has participated in the development of a new CliniVision product to facilitate decision support. A larger flat-screen hand held will allow the user to work through the actual protocol algorithm on a touch screen. Key evaluative elements are captured and a care plan determined. This new visual approach will facilitate any clinical situation in which information is collected to make specific decisions regarding a patients care plan. The future will bring new opportunities to enhance care delivery as new technology and applications are developed.