The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

Key Factors in RCPs Performance of Therapist-Driven Protocols

William J. Beach MBA RRT, Jewish Hospital Heart and Lung Institute, Louisville, KY

Purpose: Growing acceptance of Therapist Driven Protocols (TDPs) has placed new demands on the Respiratory Care Professional (RCP). This study was designed to identify the factors influencing the RCP's performance of TDPs.


A standard survey was developed with a series of questions devoted to five separate categories, including hospital background, department information, TDP information, staff background, and continuing education. Four hundred surveys were mailed to departments across the United States. Departments were selected randomly, but with each state represented to assure geographic dispersal.

Results: One hundred sixty surveys were returned. Thirty-eight were discarded for gross incompleteness. Twenty-eight, (23%) were excluded because the departments did not measure their staff's TDP compliance, or quality of TDP performance. Ninety-four, (24 %) remained for statistical analysis. A correlation matrix was constructed, and the most positive and negative correlations to measurements of compliance and quality of protocol performance were identified. Standard deviations and "p" values were calculated.

Conclusions: The most direct correlation established was between compliance scores and those for quality of performance (0.750; p=0.001). The greatest positive extrinsic compliance factor was management's expectation of compliance (0.276; p=0.001), followed by the percentage of all therapy covered by protocols (0.116; p=0.002). The largest negative correlation was the percentage of eligible protocol therapy excluded by physician order as "No Protocol" (-0.304; p=0.004). The only factor with statistically significant correlation with measured quality was the use of a TDP credentialing process, (0.207; p=0.003). Perhaps equally significant was the failure of numerous "conventional wisdom" factors to demonstrate correlation. These include years of post-secondary education, average years of experience of the staff, size of the hospital, and level of credentialing. An important factor that became evident upon examination of the data, was the wide range of understanding as to what constitutes a "TDP Department."

Clinical Implications: Understanding key factors in acceptance and performance of TDPs, and overcoming assumptions about reasons for compliance problems, is crucial to a successful implementation strategy. Therapists who can demonstrate quality performance, managers that expect compliance, and physicians that resist writing "No Protocol" orders are the key components of success.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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