The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

AN ASSESSMENT OF THE APPROPRIATENESS OF RESPIRATORY CARE DELIVERED AT A 450-BED ACUTE CARE VETERANS ADMINISTRATION HOSPITAL.

David C. Shelledy, PhD, RRT; Terry S. LeGrand, PhD, RRT; Arthur P. Jones, EdD, RRT; Wayne Lawson, MS, RRT; Robert Holmes, BS, CRTT; Ryan J. Tibball, BS, CRTT. The University of Texas Health Science Center at San Antonio, Texas.

INTRODUCTION: The current economics of health care delivery in the acute care setting have produced significant pressures on providers to reduce the cost of care. Respiratory care is expensive and time-intensive and the provision of inappropriate or unnecessary caro may waste scarce resources. Further, a failure to provide necessary and appropriate respiratory care may have an adverse impact on patient outcomes. In an attempt to improve patient outcomes, control costs, and reduce length of stay, some providers have developed protocols to insure that patients receive appropriate care and that inappropriate or unnecessary care is minimized. The purpose of this study was to determine the appropriateness of basic respiratory care delivered at a 450-bed veterans administration hospital during a three-month time interval. Specific questions addressed were: 1) What is the frequency of ordered and provided basic respiratory care which is not indicated based on the AARC clinical practice guidelines? and 2) What is the frequency of basic respiratory care which is indicated based on the AARC clinical practice guidelines but NOT ordered or provided? Methods: Five assessment days beginning in January and at two-week intervals ending in March of 1998 were selected to conduct the study. All patients admitted to the hospital and receiving basic respiratory care received a complete respiratory care assessment including medical records review, patient interview, physical assessment and measurement of SpO_{2} and inspiratory capacity. Patients in the intensive care units were excluded from the study. The assessment instrument provided a standardized format for assessment of respiratory care based on AARC clinical practice guidelines. Results: Seventy-five patients received complete assessments including chart review, interviews and physical assessment. Of these, 52 patients were receiving oxygen therapy, 58 patients were receiving aerosol bronchodilator therapy, seven were receiving mucolytic therapy, 13 were receiving lung expansion therapy, eight were receiving chest physiotherapy and six patients were receiving anti-inflammatory inhaled aerosols. For oxygen therapy, 17.65% of the ordered therapy was not indicated. For all categories of aerosolized medications (bronchodilators, mucolytics, anti-inflammatory agents), 32.4% of the ordered respiratory care was not indicated. The percentages of ordered therapy that was not indicated for chest physiotherapy and lung expansion therapy was 37.5% and 7.7%, respectively. On average, 11.825% of the patients assessed were not receiving respiratory care which was indicated based on clinical practice guidelines. Of these, 5.3% of patients met criteria for oxygen therapy but were not receiving the care, 5.3% of patients met criteria for bronchodilator therapy, and 36% of patients met criteria for lung expansion therapy which was not ordered or received. CONCLUSION: On average, 24.8% of basic respiratory care procedures ordered were not indicated and about 11.8% of patients reviewed were not receiving care that was indicated. Inappropriate utilization of respiratory care services may increase costs and produce undesirable outcomes in terms of morbidity, mortality and length of stay.

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

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