The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

EXPERIENCE WITH RESPIRATORY CARE PROTOCOLS IN A LARGE HEALTHCARE NETWORK

James K. Stoller, MD, Lucy Kester, MBA, RRT, FAARC, Cleveland Clinic Foundation, Cleveland, Ohio

Background: Respiratory care protocols have been shown to improve the allocation of respiratory care services in large tertiary care medical centers. However, little attention has been given to evaluating protocols in settings other than teaching hospitals. To address questions regarding the use of respiratory protocols in smaller community hospitals, we undertook a study of protocol use throughout the Cleveland Clinic Health System (CCHS). The CCHS is a consortium that includes 9 Cleveland hospitals.

Methods:
Data were collected during a meeting of Respiratory Care Department representatives from 7 of the 9 participating CCHS hospitals, where each hospital presented their experience with respiratory protocols. Following the meeting, a structured questionnaire was distributed to each of the CCHS hospitals with a request to submit all missing data.

Results:
Table 1 presents the findings.

Misallocation Factors Creating
Hospital Number of Beds % Over Ordering %Under Ordering a Need for RT Protocols Protocol Type and Start Date Improved Allocation?
The Cleveland Clinic 1,192 25% 11% Misallocation, Decreased staff morale Consult Service Pilot, Feb. 1992 YES NO
X
Euclid 371 67% 2% Misallocation Consult Service Pilot, Dec. 1996 X
South Points 364 42% 17% Misallocation Consult Service Pilot, Nov. 1997 X
Hillcrest 360 63% 15% Misallocation Consult Service Pilot, Aug. 1999 X
Lakewood 400 3% Misallocation in 1992 Interest on part of Medical Director Dept. Manager and staff Aerosol to MDI 1993 Oxygen 1997 RTCS July 1999 ?
Fairview 478 Increased LOS Increased readmits Management Protocol for Pediatric Asthma X
Marymount 279 48% 3% Misallocation - Unable to complain 10% of ordered therapy Consult Service Pilot, Nov. 1997 X
Lutheran 204
Huron Road 379



Conclusions: 1. Strategies for implementing respiratory protocols must be customized for the environment of individual hospitals. 2. Methods for monitoring the effectiveness of protocols vary among institutions. 3. Respiratory care protocols reduce the misallocation of respiratory care services not only in teaching hospitals, but also in a variety of smaller, community-based hospitals. 4. Our findings suggest that the efficacy of respiratory care protocols to improve allocation extends to community-based institutions, though further study is needed.
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