2003 OPEN FORUM Abstracts
LONG-TERM EXPERIENCE WITH A QUALITY CONTROL STRATEGY FOR A RESPIRATORY THERAPY CONSULT SERVICE.
Lucy Kester, R.R.T., M.B.A., FAARC, James K. Stoller, M.D., M.S, FAARC. The Cleveland Clinic Foundation, Cleveland, Ohio.
Introduction: Because a quality monitoring process is an essential component of a respiratory therapy protocol program, the Respiratory Therapy Consult Service (RTCS) at the Cleveland Clinic Foundation incorporated an audit/feedback process soon after its inception in 1994. Developed with a goal of assuring standard application of a structured system for writing a respiratory care plan, the audit system compares the therapists' patient assessments and care plans with the assessments and care plans of a highly experienced auditor conducted on the same patient within a 24-hour interval. Previously reported results of earlier experience (1996-1998) with the audit program showed a high frequency of agreement between the therapist evaluators and the auditor. In the context of growth of our Respiratory Therapy Section and an increasing volume of respiratory therapies delivered, the current study was undertaken to assess the more recent audit experience (1998-2002).
Methods: Audits were conducted in a convenience sample of 8 patients per month by the education coordinator, who has been instrumental in the implementationhas helped develop and implement and development of thethe Respiratory Therapy Consult Service. for over10 years. Audits compared the percent agreement with which the auditor's 9-category patient assessments and 6-therapeutic treatment modality care plans agreed with therapist evaluators' assessments and care plans. Other items assessed were the percent agreement between the auditor and the evaluators for therapy treatment frequencies, the timeliness of care plan completion (i.e., within 8 hours of receipt of the consult order), and the completeness of the written consult form (i.e., containing date, time, indications, signatures, etc.). Growth between 1998-2002 was measured by an increase in the number of patients receiving respiratory therapy (from 22,080 to- 24,738, 12.0 % increase), the total number of therapies administered (from 169,636 to- 191,576, 12.9 % increase), the number of full-time
eequivalent respiratory therapists in our Section (from 95.5- to 97.5, 1.0 % increase), and the number of service counts administered per full time-equivalent respiratory therapists (from 5,996- to 7,398, 23.4 % rise).
Results: Over the same period (Table 1), the percent of concordance between the auditor and the therapist evaluator regarding the assessment scores increased from 91.5% to 96.0% (p= 0.05). The percent of concordance on care plans increased from 96.8% to 97.9% (p=0.05), and the rate of achieving timely completion of the consult increased from 94% to 99% (p=0.05). Only the completeness of the written form declined slightly (from 73%- to 70%) between 1998-2002.
Table 1: Results of Audits, 1998 - 2002
Conclusions: 1. Even in the face of growth of the department and growth of respiratory therapy clinical volume, the rates of concordance between the auditor and the therapist evaluators remained high and continued to improve over time.
2. The improved performance achieved in the face of this growth indicates maintenance of high process quality in administering the Respiratory Therapy Consult Service.