The Science Journal of the American Association for Respiratory Care

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
2001 vs. 1991

Service 1991 1996 2001
Aerosolized
Bronchodilators (SVN)
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
Therapies/Patient 11.9 8.9 7.9

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.

OF-02-086

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