1998 OPEN FORUM Abstracts
EFFECTIVE ALLOCATION OF PEDIATRIC RESPIRATORY CARE USING PATIENT CENTERED RESPIRATORY CARE PROTOCOLS
Otwell Timmons, M.D., Lucy Brucoli, R.R.T., David Fisher, M.D., Carolinas Medical Center, Charlotte, N.C., and John Salyer, R.R.T. Primary Children's Medical Center, Salt Lake City, Ut.
We identified inappropriate use of chest physiotherapy(CPT), inappropriate use of bronchodilators by hand-held nebulizer(HHN), and under-use of metered-dose inhalers (MDI) in the pediatric areas of our hospital.
We adapted successful therapist-driven protocols(TDPs) from Primary Children's Medical Center to fit the local practices and preferences. We made MDIs with spacers our default brochodilator delivery devices. Operation of the TDP requires historical information and current physical exam, done by the RCP. The TDP is entirely patient-focused. Care decisions are based on published trials. TDPs have operated for over one year in our hospital.
Though the number of patients admitted with respiratory diagnoses increased compared with the previous year, we decreased the number of CPT and HHN treatments. We increased the usage of MDIs, as desired. Department costs declined $23,000 and patient charges decreased $76,000 in the first year of the TDP. Per patient charges declined 22%, from $712 to $555. As we gave fewer treatments, we saw no increase in length of stay or in transfers to the ICU for respiratory diagnoses.
Conclusions: 1) Successful TDPs can be generalized to other hospitals; 2) Patient-centered TDPs preserve quality and reduce costs.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.