1997 OPEN FORUM Abstracts
The Economic Impact of a Respiratory Care Consult Program
J. Sestito, MS, RRT, P. Arrington, BA, RRT, M. Santoro, MBA, RRT, D. Shulkin, M.D., J. Hansen-Flaschen, M.D., D. Reily, BS, RRT, Lynda Gradwell, MS, RRT, H. Palevsky, M.D. University of Pennsylvania Medical Center, Phila., Pa.
INTRODUCTION: A respiratory consult system was implemented in response to inappropriate ordering of respiratory care in non-ICU settings. Inappropriate therapies consistently were maintained at a 30% rate for the past four years. We have previously reported the success of this program, The Effect of A Consult Service on Inappropriate Therapies. The Respiratory Consult Service evaluates patients and recommends therapy or discontinuation of therapy based on guidelines. These guidelines were formulated by a multi-disciplinary committee and approved by the Medical Board of the hospital. A respiratory consult is triggered when a new order is generated by a physician or if the physician requests a respiratory care consult. Methods: A study was conducted evaluating 197 consultations after a physician ordered respiratory therapy. In fifty-eight (58) of the 197 orders, the consult therapist recommended additional therapy. In seventy-eight (78) of the 197 orders, the consult therapist recommended to discontinue ordered therapy and in sixty-one (61) of the remaining orders, the consult therapist recommended to modify the physician's order. Therapy volume saved was calculated based upon the average patient receiving three days of therapy. Chest Physical Therapy volume was calculated based upon a patient receiving 4 treatments per day (QID) for a total of 12 tx.'s per patient (20 min. of labor). Hand Held Nebulizer (HHN) averaged 6 tx's per day (Q4) for a total of 18 treatments per patient (15 min. labor). Metered Dose Inhaler (MDI) is equivalent to 10 min. of labor and was recommended Q4 (18 treatments per stay), Q6 (12 treatments) or self-administered which equaled 30 min. of training and scoring one time. Results: In the 58 orders adding therapy, the consult service added 94.5 hrs. of labor to deliver 402 MDI tx.'s, instruct 28 patients to self-administer MDI's and 54 HHN treatments. 78 orders reviewed by the respiratory consult service recommended to discontinue therapy. This resulted in the elimination of 1,122 treatments (564 CPT tx.'s and 558 HHN tx.'s) which corresponds to 327.5 hours of labor. The remaining 61 of the 197 orders recommended to convert HHN therapy (1,098 tx.'s requiring 274.5 hrs. of labor) to MDI therapy (1,098 tx.'s requiring 183 hrs. of labor). This modification of physician orders saved 91.5 hrs. of labor. The consult service used one hour of labor for each of the 197 consultations resulting in a total of 197 hrs.Net savings are calculated below. Labor Analysis: Sayings from Consult - 419 hrs. (327.5 hrs. from elimination of therapy, 91.5 hrs. HHN to MDI conversion. Expense from Consult - 291.5 hrs. (94.5 hr.from added therapy, 197 hrs. performing consults) Net Labor Savings - 127.5 hrs. ($2,550 in salary). CONCLUSION: The Respiratory Care Consult service saved 127.5 hrs. of labor. Without the consult service 510.5 hrs. of labor would have been added to the volume of the department The service has not added additional expense to the department. In an era of critical pathways and the need to eliminate unnecessary care, the consult system ensures the delivery of appropriate care while improving distribution of human resources.