2002 OPEN FORUM Abstracts
CHANGING PATTERNS OF RESPIRATORY CARE INPATIENT SERVICES.
Douglas K. Orens, MBA, RRT, Lucy Kester, MBA,RRT,FAARC, James K. Stoller, MS, MD, FAARC, The Cleveland Clinic Foundation, Cleveland, Ohio.
Background: In the context of hospital growth and markedly increasing severity of inpatientsÕ illness over time, changes in the volume and types of inpatient respiratory care services are expected. To assess these changes in a large tertiary care hospital, we examined the trends in the volume, percent distribution, and cost per patient of respiratory care services provided by the Section of Respiratory Therapy at the Cleveland Clinic Hospital.
Methods: The volume of respiratory care services was tracked using CliniVision, (Mallinkrodt, St. Louis, MO). Actual fixed and variable costs were tracked using Transition Systems accounting software (TSI, Boston, MA.), which has been in use in our hospital since 199(__). The designation of Òhigh volume therapyÓ was applied to those 5 services accounting for the highest proportion delivered in 1991. Results: Table 1 presents the volume and types of respiratory care services delivered at the Cleveland Clinic Hospital in the years 1991, 1996, and 2001. Despite a 47.8% rise in the number of hospitalized patients per year from 1991 to 2001, the total number of high-volume treatments administered decreased slightly (by 1.9%), so that the number of therapies per patient declined by 34% (from 11.9 to 7.9).
Table 1. Type and Trends of High-Volume Respiratory Care Services Delivered
Number of Treatments by Year
% Change in Fraction
|68,029 (35%)||47,498 (32%)||72,692 (36%)||9% |
|MDI||22,513 (11%)||26,371 (18%)||36,005 (18%)||64% |
|Oxygen||50,067 (24%)||40,316 (28%)||51,624 (26%)||4% |
|Incentive Spirometry||22,199 (11%)||19,018 (13%)||27,045 (14%)||27% |
|Bronchopulmonary Hygiene||39,990 (19%)||13,898 (9%)||11,542 (6%)||71% ¯|
|Total Therapies||202,728 (100%)||147,101 (100%)||198,908 (100%)|
|Total Patients Receiving Resp Care||16,989||16,556||25,117|
A concomitant 35% reduction in cost (from $93.98 to $61.07 per patient) was observed. Over the decade analyzed, bronchodilator therapies comprised a larger percentage of all high-volume treatments (45% to 55%), with a rising proportion of therapies administered as MDIÕs (25% in 1991 to 33% in 2001). Bronchopulmonary hygiene demonstrated the largest reduction in absolute volume of respiratory therapies administered (71% decline).
Conclusions: We conclude that: 1. Dispute a rising hospital census, the absolute volume and the number of high-volume therapies per patient have declined between 1991 and 2001. 2. Among the 5 high-volume therapies assessed, bronchopulmonary hygiene showed the largest absolute and proportionate decline in use. 3. In the context that the Respiratory Therapy Consult Service was first implemented in 1992, we speculate that these trends reflect the benefit of better allocation of respiratory care services conferred by use of a respiratory care protocol service.