1998 OPEN FORUM Abstracts
THE PEDIATRIC EXPERIENCE: INITIATION OF AN INTERDISCIPLINARY FLOOR ASSESSMENT TEAM (FAT).
Karen Baldesare-Burton RN RRT, John Salyer BS, RRT. Primary Children's Medical Center, Salt Lake City, UT.
Background: In 1995-96, at our 240-bed tertiary care pediatric center, non-ICU nurses were cross trained to administer certain high-volume, low risk respiratory care procedures, including chest physiotherapy (CPT), pulse oximetry (Pox) and aerosolized bronchodilators (ABD). Patient driven protocols existed for each of these interventions. From a previous study (Lugo et al. Pharmacotherapy 1998; 18(1):198-202) we determined that ABD were overutilized in our bronchiolitis population, with over 94 % of patients who did not respond to ABD's in the ED continued to receive treatments after admission, and 87% who did not respond to ABD's after admission continued to receive the therapy. For the 1996-97 winter season we introduced a clinical practice guideline (CPG) to reduce these unwarranted variations, specifically in patients with bronchiolitis. After one season, we found no reduction in these variations. We then developed a dedicated interdisciplinary team (FAT) to help reduce variations in the use of these interventions and thereby lower costs to the community. Five RCP and three support role RN positions were created to oversee all existing protocols. Actual treatments would still be given principally by RN's. We speculated that this new delivery model would improve communication and cooperation between services. Costs & Utilization: Training was extensive and cost $8282 (excluding nursing hours). All eight employees attended an intensive two week orientation, which included lectures on chest-radiography, pulmonary assessment, pharmacology, the scientific basis for the use of all four respiratory interventions, basic CQI principles, and the outcome measures we would be assessing. The RN's are granted 6 to 12 hours each per pay period to perform the functions of the support role, such as unit education, data gathering, meetings, and in-services. Two RCP's were assigned to the general medical surgical units on days and one on evenings, 7 days per week and charged with assessing all bronchiolitis patients and reducing when possible the overutilization of the previously mentioned interventions. Results: We admitted 540 bronchiolitis patients as of 3/16/98. Mann-Whitney U-test revealed statistically significant (P < 0.05) decreases in utilization between the 96-97 & 97-98 bronchiolitis season for aerosolized bronchodilators (decreased 38%), continuous pulse oximetry (decreased 34%), and chest physiotherapy (decreased 27%). We also discovered that only 19% of patients who did not respond to ABD's continued to receive treatments after admission. During this period, no patients were re-admitted after discharge from the hospital. Length of stay in this population was not statistically different than in the previous year.
Discussion: Had we been under treating this population we would have expected prolonged lengths of stay or possible readmissions due to exacerbation of their bronchiolitis. We attribute these decreases in unwarranted variation to the presence of FAT RCP's working together with the physicians and nurses, and the application of our patient driven, intervention based protocols for CPT, ABD, and Pox. We believe this has resulted in a basic change in culture on these medical surgical units.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.