The Science Journal of the American Association for Respiratory Care
BACKGROUND: The use of Chest Physiotherapy (CPT), a component of bronchial hygiene therapy, has been demonstrated to be an effective therapeutic intervention in a number of disease entities. The patients that benefit from CPT have disease processes characterized by increased sputum volume, viscosity or ineffective mucocilliary clearance mechanisms. Conversely, the use of CPT has been shown to be of little or no benefit in diseases without these characteristics. Clinical deterioration of patients has been observed when CPT is used inappropriately. PROBLEM: After reviewing data regarding CPT utilization patterns within our institution, it was concluded a large number of ordered CPTs were inappropriate when compared with clinical indications from published studies and the AARCs CPG ?Postural Drainage Therapy?. Our management team and the Medical Director felt that development and implementation of a CPT protocol would reduce the number unnecessary CPTs being ordered. Our institution's CPT protocol was implemented in December of 1998.
Methods: We compared the data from the three busiest months of the year within our institution, December, January and February, for the year (97-98) prior to implementation of our CPT protocol with data for the same three month period (98-99) after CPT protocol implementation. The number of CPTs ordered in 96-97 was compared to 97-98 data to ensure our ?before? data wasn't an unusual variance. The volume of CPTs ordered 96-97 and 97-98 (pre-protocol data) were found to be comparable. Each CPT was assigned a 15
|CPT Procedures||Cost of Service||% Reduction||Cost Savings|
|Pre-Protocol (Dec-Jan-Feb 97-98)||20,647||$106,848.23|
|Post- Protocol (Dec-Jan-Feb 98-99)||9,567||$49,509.23|
|% Reduction (CPTs Procedures)||53.7%|
Prior to the CPT protocol implementation 9.92 FTEs were required to provide this service while after protocol implementation 4.60 FTEs were required. This resulted in the equivalent of 5.32 FTEs that could be redirected to more appropriate clinical activities. Outcome data is currently being collected to ensure appropriate patient selection for CPT. EXPERIENCE: The authors have 31 years of combined experience in Respiratory Care with each participating in previous protocol development. CONCLUSION: Implementation of a CPT protocol, with appropriate medical and administrative support, can result in significant cost savings and can allow redirection of valuable FTEs to more appropriate clinical activities.