2002 OPEN FORUM Abstracts
VALIDITY OF THERAPIST PERFORMED BEDSIDE SPIROMETRY USING PURITAN BENNETT RENAISSANCE SPIROMETRY SYSTEM
Jim Rebel RRT, Mike Trevino RRT, Gary L. Weinstein MD, FCCP, Presbyterian Hospital of Dallas, Dallas, Texas
Background: The Respiratory Care department performed 1,115 spirometry studies between January and December 2001. Of these, 147 were performed at the patient?s bedside. The department uses the Puritan Bennett Renaissance (PB100) spirometry system. The remainder of all studies was performed in the Pulmonary Lab. Bedside spirometry is one of the least performed procedures that therapists, in our facility, are required to perform. The purpose of this study was to evaluate the quality of bedside spirometry performed.
Methods: A retrospective review identified that thirty-eight different therapists performed bedside spirometry. Sixty-three patients were screened for spirometry only, and an additional eighty-six patients had pre-and-post spirometry performed. Acceptability and reproducibility were assessed against the revised AARC Clinical Practice Guidelines for Spirometry that is largely based on American Thoracic Society (ATS) standards.
The tests were further evaluated to identify the root cause of failure. These cover two broad categories, therapist error and patient effort. Therapist error was defined as the acceptance of a failed test with minimal trials. Patient effort or ability was defined as a poor effort stated on the report by the administering therapists or the inability to perform a reproducible effort.
|SPIROMETRIES||Passes AARC CPG||Failed AARC CPG|
|Pre & Post BD (n=86)||10.5% (9)||89.5% (77)|
|Pre BD Only (n=61)||31.1% (19)||68.9% (42)|
|Total (n=147)||19.0% (28)||81.0% (119)|
|FAILED TEST||Therapist Error||Pt. Effort or Ability|
|Failed Pre & Post (n=77)||67.5% (52)||32.5% (25)|
|Failed Pre BD Only (n=42)||57.1% (24)||42.9% (18)|
|Total (n=119)||63.9% (76)||36.1% (43)|
Conclusions: Of the 119 bedside spirometry screening tests performed that did not meet acceptability criteria, 63.9% were attributed to therapist error. These results demonstrate the need to monitor all clinical services on an ongoing basis, particularly where a large staff is involved in performing low volume procedures. Identified opportunities as a result of this study include; 1) an enhanced monitoring of low volume procedures, 2) a continued focus on clinical competencies, and 3) the establishment of criteria for spirometry to be performed in the Pulmonary Lab when acceptable results are unattainable at the bedside.