The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

THERAPIST DRIVEN PROTOCOLS: EFFECTIVENESS OF IMPLEMENTATION

Eric Rutherford, Heather Zoderer, Melissa Overton, AS, RRT, Respiratory Therapy Program Indiana University, Richard Cormican, BS, RRT, Clarian Health, Linda Van Scoder, EdD, RRT, Associate Professor, Respiratory Therapy Program, Indiana University.

Background: Studies have shown better allocation of respiratory services when therapist driven protocols (TDPs) were used. Other demonstrated benefits of TDPs are standardized medical practices, lower costs and improved quality of life without causing adverse effects. This study was completed retrospectively with the purpose of determining if the implementation of non-ICU respiratory TDPs at a large, mid-western hospital had the expected benefits of more optimum allocation of treatment modalities and more adequate follow-up reassessment for the modalities ordered.

Methods: A control group (53) and an experimental group (50) of persons at least 18 years of age who received aerosol therapy with bronchodilators or vasoconstrictors, volumes expansion therapy or broncho-pulmonary hygiene by respiratory therapists (RTs) in a non-ICU setting and who were not treated by a pulmonologist. The control group was chosen from the year prior to implementation of the patient assessment program (TDPs), and the experimental group from the period that the assessment program has been in use. The subjects were selected by systematic randomization. The medical records were reviewed to determine if proper indications existed for the therapy and if follow-up reassessment of the therapy occurred within 72 hours of the order. To establish inter-rater reliability, the 3 evaluators initially reviewed the same 8 records and made identical conclusions by following Cleveland Clinic?s respiratory treatment algorithms, which are based on the American Association for Respiratory Care (AARC) Clinical Practice Guidelines (CPGs). The chi-squared test was used to determine whether the groups had a significantly different incidence of proper indication and whether the groups had a significantly different incidence of follow-up assessment within 72 hours.

Results: The percent of overall therapy that met proper indications with TDPs was not significantly improved over physician ordered therapy. Appropriateness of therapy for bronchodilators was better with TDPs than when physician ordered but for IS, physician ordered therapy showed a higher rate of meeting proper indications. A significant improvement in follow-up assessment was demonstrated with TDPs.

Protocol Indications and Follow-up Assessment

  overall indications

bronchodilator indications

IS indications follow-up assessment
criteria control (N=55) exp (N=57) control (N=21) exp (N=28) control (N=29) exp (N=25) control (N=47) exp (N=39)
met 41 45 12 24 26 18 31 35
not met 14 12 9 4 3 7 16 4
% met 75% 79% 57% 86% 90% 72% 66% 90%
p value 0.581 0.025 0.096 0.009

Conclusions: The outcome of this study does not demonstrate a significant difference between the appropriateness of respiratory therapy when ordered by a physician (75%) and when guided by RTs (79%) but it does show that RTs were at least as successful as physicians at ensuring that proper indications existed. In addition, follow-up assessment significantly improved when performed by RTs (90%) compared to follow-up by physicians (66%). This is significant because treatment given when no longer indicated adds unnecessary costs to an already overburdened healthcare budget. Therefore, the implementation of the respiratory patient assessment program was demonstrated to be beneficial.

OF-02-028

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