The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

THE FREQUENCY OF BASIC RESPIRATORY CARE PROCEDURES THAT ARE ORDERED BUT NOT INDICATED IN A PATIENT POPULATION IN AN ACUTE CARE MEDICAL CENTER.

Terry S. LeGrand, PhD, RRT, Arthur P. Jones, EdD, RRT, Wayne Lawson, MS, RRT, Oliver J. Drumheller, EdD, RRT, and David C. Shelledy, PhD, RRT, The University of Texas Health Science Center at San Antonio, San Antonio, TX.

Managed care, cost-containment, and capitation are trends that currently dictate the provision of health care. Rising costs have been instrumental in establishing these trends, thus it is vitally important to carefully assess patients receiving medical services, including respiratory care services, to determine the appropriateness of ordered therapy. Objective: To determine if respiratory care assessment specialists could play an important role in contributing to the cost-effectiveness of administered respiratory therapies. It would be the task of such specialists to establish whether ordered procedures are indicated for a given patient, based on criteria set forth in the AARC Clinical Practice Guidelines. Methods: An internal quality control audit of patients receiving basic respiratory care was conducted at a 386-bed acute care medical center. Full patient assessments including chart review, patient interview, physical assessment, and assessment of therapy were performed during a one-week period by respiratory care personnel on 71 patients, utilizing a patient care assessment instrument designed for this purpose and previously field-tested. The andit included determination of ordered therapy, as well as systematic analyses of indications for therapy. Audited treatment modalities included oxygen therapy, small volume nebulizer treatments, MDI administration, IPPB, and chest physical therapy (CPT). Results: Of 65 patients receiving O_{2} therapy, 67.7% (44) of the ordered therapy was not indicated according to AARC Clinical Practice Guidelines. Of 41 patients receiving small volume nebulizer therapy, 43.9% (18) exhibited no indications for the therapy. Other therapeutic procedures comprised a small percentage of ordered therapies, thus findings about those procedures may not be conclusive. Six MDI orders were evaluated, of which 100% were indicated. Four patients were receiving IPPB treatments, yet there were no indications shown for any of the patients receiving the treatment. Of the 4 CPT orders identified, all were indicated. Based on available data from fiscal year 1996 provided by this hospital, elimination of inappropriately ordered small volume nebulizer therapy alone would save approximately $191,700 annually. Conclusions: The findings from this study show that a significant proportion of oxygen therapy, as well as an appreciable number of small volume nebulizer treatments and perhaps other respiratory care services ordered for this patient population, were not indicated according to a complete patient assessment and documentation of signs and symptoms in the hospital record. The addition of full time assessment specialists to the respiratory care services staff, whose function it is to perform detailed chart audits and patient assessments, would be expected to reduce the overall cost of delivered respiratory care services. Furthermore, assessment specialists would ensure that patients do not receive unneeded therapies, and that they do receive those therapies that are not ordered but are in fact indicated. Unnecessary and inappropriate care increases costs and may lower the quality of care provided.

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

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