2004 OPEN FORUM Abstracts
PROTOCOL DIARIES: A NINE-MONTH EVALUATION
Karen
M. Sicard, RRT, Clinical Specialist, Department of Respiratory
Care Services, WellStar Health System, Austell, GA, Lynda T.
Goodfellow, Ed.D., RRT, FAARC, Georgia State University, Atlanta, GA
USA
Introduction:
In the current healthcare climate of cost containment, WellStar
Health System Respiratory Care Services needed a mechanism for
increasing cost savings while standardizing the care. Prior to
implementation, staff development and training for a change in
culture took place over a year and half period for 177 therapists,
the medical staff, nursing and other disciplines impacted by the
protocol process.
Methods:
We developed protocols for RT consultation and therapy based on
literature reviews. The “Respiratory Care by Protocol”
consultation was fully functional for two-service lines, Chronic
Obstructive Pulmonary Disease (COPD) and Simple Pneumonia (SP) at the
5 facilities on July 1, 2003. Concurrently, we reevaluated the work
units and workload performed to capture the reality of workload by
the therapist. We also standardized the policies and procedures
across all hospitals allowing for flex of staffing as needed. The
medication occurrences (medication errors) were reviewed weekly.
Results:
The first nine-months of FY04 showed 13,791 assessments performed
with 4,471 patients (32%) placed on RC by Protocol. Table 1 presents
the average therapy savings per case of the 3888 COPD and SP cases
reviewed along with the average length of stay (ALOS) and use of
oxygen per day decreased for the first nine-months of the protocol
program. Missed treatments from July 01-Mar 02 were 1192 of 239,876
ordered therapy (0.50%) with a decrease for July 03-Mar 04, 907 of
224,609 ordered therapy (0.40%) after protocol implementation.
The process is still ongoing.
Table
1. Decrease in services per case after protocol implementation.
| Oxygen days | Nebulizer Rx | MDI Rx | ALOS | |
| COPD | 1.43 | 11.51 | 2.24 | 2.24 |
| S. Pneumonia | 1.09 | 7.37 | 0.87 | 2.26 |
Conclusion:
This process of “Respiratory Care by Protocol” has
lead to a decrease of misallocation of care, in two patient
populations. In COPD and SP there was a decrease in the number of
nebulizer and MDI therapy delivered while the ALOS did not increase
creating a cost savings for these groups. The use of protocols also
decreased workload, directly affecting and decreasing the medication
occurrences for the system.