1997 OPEN FORUM Abstracts
THERAPIST DRIVEN PROTOCOL (TDP) IN A CHILDREN'S HOSPITAL: ENHANCED PATIENT CARE, RESOURCE UTILIZATION, AND MEDICAL STAFF EDUCATION.
Marc Leaderstorf, RRT, Dale Bloomberg, RRT, Patricia Mauro-Schukraft, RRT, Corinne L. Leach, MD, PhD. Departments of Respiratory Care and Pediatrics, Children's Hospital of Buffalo, State University of Buffalo, Buffalo, NY.
Background: TDP's have been developed in recent years to optimize resource utilization in the adult hospital setting. We hypothesized that a respiratory care practitioner's (RCP) expertise in evaluation and treatment of patients requiring respiratory care could be more effectively applied in a tertiary care pediatric teaching hospital. Methods: Two hundred thirty one pediatric patients who required respiratory intervention during a single hospital stay were managed by either a private physician (control group) or according to TDP's (TDP group). A team of RCP's and medical faculty in Pediatric Allergy and Immunology, Pulmonology, University Pediatrics, and private practice developed an evaluation program. This included a format for comprehensive respiratory assessment on admission based on history, physical exam, chest radiographs, and laboraties, from which a determination of severity of illness (triage score) was made. The triage score was used to determine frequency of treatments which were deemed appropriate according to algorithms for bronchodilator aerosol treatments and chest physical therapy. Algorithms were derived for bland aerosol (tent), and croup therapy as well. Through this evaluation program, the RCP formally recommended a course of treatment. The resident also evaluated the patient according to the TDP, and after discussion and agreement on a treatment plan with the RCP, wrote orders. Patients were reevaluated by the RCP at the time of each treatment, and plans adjusted as needed. Patient days, number of treatments, hours of therapy, severity of illness, and readmissions were recorded. Results: For patients with reactive airway disease (RAD), the TDP group (n=38) showed a 29% decrease in oxygen hours per patient, a 15% decrease in tent hours, and a 35% decrease in number of aerosol treatments per patient as compared with the control group (n=193). Length of stay was decreased 14% in the TDP group, with no increase in readmissions. Greater reductions were shown in patients with croup (control.n=58; TDP n=16; Table).
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Experience: The initiation of TDP's in a university teaching hospital presented unique challenges, in particular the development of mutually acceptable treatment plans by the housestaff, private physician and RCP. The overall professional interaction between RCP and physician expanded. Many private physicians requested the evaluation program for their patients, and it has since expanded to include all non-intubated pediatric patients who require respiratory care. Through this TDP program, a standard for respiratory evaluation was developed, from which both physician and RCP draw. Conclusion: TDP's appear to optimize respiratory care resource utilization, while enhancing patient care. A strong, cooperative team approach between RCP and physician is needed to make this system work.