The Science Journal of the American Association for Respiratory Care

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.


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