1997 OPEN FORUM Abstracts
A METHOD FOR EVALUATING RESPIRATORY THERAPISTS' CARE PLANS FOR A RESPIRATORY THERAPY CONSULT SERVICE.
Lucy Kester, MBA, RRT, James K. Stoller, MD, Cleveland Clinic Foundation, Cleveland, Ohio.
BACKGROUND: The Respiratory Therapy Consult Service (RTCS) was initiated in 1992 and has been mandated to direct the respiratory care provided to most adult non-ICU inpatients at the Cleveland Clinic Foundation since December, 1994. A respiratory therapy consult is generated when a physician writes an order for a consult or when specific orders are written for respiratory therapy treatments. In performing a consult, a therapist evaluator sees the patient, conducts an assessment using specific indications and then, following associated algorithms, writes a care plan. To help assure that the care plans being written by the Respiratory Therapist evaluators are appropriate, we initiated an audit strategy in March, 1996, as described below. METHOD: Two care plans per week are audited by our education coordinator (L.K.), who sees the patient within 24 hours following the evaluation by the therapist, conducts an assessment, while blind to the other therapist's care plan, and writes a care plan based only on clinical information available at the time of the therapist's evaluation. The auditor's care plan is then compared with the therapist evaluator's plan for agreement or disagreement on each of the 8 assessment categories as well as each of the 6 care plan items. Feedback is provided to the therapist evaluator on a simple form that summarizes % agreement between the auditor and the evaluator on ratings for each of 8 assessment items and % agreement on 6 treatment modalities. Audit results are presented for the 24 patients sampled each quarter. Results: Table 1 presents the results of the first 9 months' experience rating % agreement on assessment ratings and respiratory care modalities and mean workload for the quarter, summarized by work units (WU's, where 1 WU equals 1 min.). As shown, the % agreement on assessment items and respiratory care modalities are consistently high across quarters, with greater agreement on respiratory care modalities than assessment items. Variation in workload WU's did not exert a consistent effect on % agreement, suggesting that agreement with a "gold standard" care plan was unaffected by the workload.
% Agreement on % Agreement on Average
Quarter Triage Score Items Treatment Modalities Work Load (WUs)
1 84.7% 92.6% 298.7
2 87.3% 93.0% 277.0
3 86.7% 96.5% 280.2
Care plan scores appear to be improving over time. The slightly lower assessment scores could be attributed to a change in patient status during the time elapsed between the therapist's evaluation and the auditor's evaluation, and also to a degree of subjectivity in some of the assessment categories.
1. Implementing an audit process is an important step to assure quality and consistent inter-therapist performance in a RTCS.
2. Preliminary data from the first 9 months of audits suggest high percent agreement between auditor and therapists regarding use of respiratory care modalities and assessment ratings.
3. Though longer term data are needed, this preliminary study did not suggest that workload variation within the range observed exerted an effect on correct implementation of respiratory care protocols.