The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

PROSPECTIVE EVALUATION OF A RESPIRATORY PRACTITIONER CONSULT SERVICE.

Marin H. Kollef, MD; Steven D. Shapiro, MD; Lisa Cracchilo, RRT; Donna Clayton, BS; Russ Wilner, RRT; Darnetta Clinkscale, MA. Pulmonary and Critical Care Division, Washington University School of Medicine, Department of Respiratory Therapy, Barnes-Jewish Hospital, St. Louis, MO 63110.

Background: Medical orders for respiratory therapy frequently vary according to the training and level of experience of the ordering physician. Several preliminary studies have suggested that increased input from respiratory care practitioners can improve the utilization and effectiveness of respiratory therapy. Therefore, we wanted to prospectively test the hypotheses that a respiratory care practitioner consult service would improve the overall administration of respiratory therapy in a large urban teaching hospital.

Methods: The Internal Medicine Service of Barnes-Jewish Hospital is made up of three "firms" which are independent functioning organizations of dedicated attending physicians and housestaff physicians. Patients assigned to these firms receive all of their inpatient and outpatient medical care from firm physicians. We prospectively implemented a respiratory care practitioner consult service on Firm A. All patients on firm A requested to receive respiratory therapy were formally evaluated by a registered therapist. These formal evaluations were performed in accordance with recommendations from the Barnes-Jewish Hospital Respiratory Care Protocol Resource Guide (1997 Edition). Patients in Firms B and C had their respiratory therapy orders written by firm physicians without a formal respiratory care consult. The main outcome evaluated was the presence of a discordant order. Discordant orders were defined as any order which did not include a treatment for which there was a clinical indication (e.g., chest physiotherapy for lobar atelectasis) or written orders for which there was no clinical indication (e.g., inhaled bronchodialators without clinical evidence of airway obstruction). A blinded study investigator made the determination of a discordant order based upon the hospital's Respiratory Care Protocol Resource Guide.

Results:

Firm n APACHE II Average Patients with

Score number of Discordant

RT Orders Orders (%)

A 75 9.4±4.9 12.4±17.8 18(24)

B 68 8.4±4.4 11.8±12.3 35(51)

C 83 8.8±4.8 10.7±11.2 43(52)

P value -- 0.503 0.603 < 0.001

Firm Average Number

of Discordant

Orders

A 0.3±0.5

B 0.7±0.7

C 0.6±0.7

P value < 0.001

RT=respiratory therapy; APACHE=acute physiology and chronic health evaluation

Experience: Our experience demonstrated that a respiratory care practitioner consult service can decrease the number of discordant orders resulting in either unnecessary treatments or inadequate treatments for patients.

Conclusions: Formal application of a respiratory care practitioner consult service, utilizing consensus driven protocols and practice guidelines, can reduce the numbers of discordant respiratory therapy orders.

Funded by a grant from the American Association for Respiratory Care.

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

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