The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

ContinuedValue of an Adult and Pediatric Utilization Review Program

RandyScott, BS, RCP, RRT, Michael Lum, BS, RCP, RRT, Tom Malinowski, BS, RCP,RRT, and Leo Langga, BS, RCP, RRT. Loma Linda University Medical Center and Children?s Hospital. Loma Linda, CA92354

 Background:Intermittent respiratory care (aerosol therapy, bronchial hygiene, and lunginflation) constitutes the majority of respiratory care orders in many hospitals.Unfortunately, these therapies are often inappropriately ordered. This can resultin significant cost and service overruns that do not improve clinical outcome.Our Adult and Pediatric Respiratory Care Utilization Review Programs were developedto address the following needs: (1) continuously monitor and evaluate the qualityand appropriateness of intermittent respiratory care; (2) pursue opportunitiesto improve care on a continuous basis which reduce cost but ensure high quality,and (3) ensure physician/therapist compliance to the approved utilization guidelines.We report on the impact of an aggressive, Respiratory Care utilization reviewprogram in a tertiary care medical center.

Method: Continuous,prospective review of respiratory care orders for intermittent therapy (bronchialhygiene, aerosol therapy, lung inflation) in pediatric and adult acute careenvironments (9/99 ? 3/01)). Evaluate adherence to Medical Staff approved guidelinesfor intermittent respiratory care modalities, and monitor most common reasonsfor change in ordered care.


# OrdersReviewedOrdersReviewed/Total OrdersOrdersChanged/Orders ReviewedOrdersDC?dFrequencyReduced
Peds28172817/3535 (80%)2142/2817 (76%)19%53%
Adult2521 2521/3480 (72%)1096/2521 (43%)46%33%


Over 70% of all intermittentrespiratory care orders were reviewed for appropriateness and adherence to departmentalguidelines. More orders were changed in the pediatric area than the adult area.The two major changes in care were discontinuation and frequency reduction.In 1989, our department implemented the UR program beginning in the Adult arena.Fiscally, the impact was a 40% reduction in the cost of providing RespiratoryCare Services. Based on the data from the study period, the UR program resultedin savings of $234,000.

Conclusion: Intermittentrespiratory care orders require diligent respiratory care utilization reviewand monitoring. Continual monitoring of utilization practice results in significantcost avoidance in both adult and pediatric clinical areas. Continuing effortsshould focus not only on UR controls, but also on educational efforts to changethe ordering practice of physicians.


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