The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

Impact of a Comprehensive Respiratory Therapy Patient Assessment

R Graham RRT, D Foley MPA RRT, B Sandore RRT, J Szalados MD JD MBA FCCM Unity Health System, Rochester, New York

Background: The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) requires in section PE (Assessment of Patients) that all patients receiving Respiratory Therapy (RT) be evaluated for efficacy of ordered therapy (P.E.1, P.E.1.1, P.E.1.3, P.E.1.7). Unity Health System received a Supplemental Recommendation on the 2003 survey in this area, and responded by creating a Comprehensive Patient Assessment (CPA) for those patients receiving RT services. The CPA consists of two parts: An Initial and a 72 hour Follow-Up Assessment. They include recent lab and radiology results, along with a physical assessment of the patient. The goal of the CPA is to ensure that patients ordered for RT are indeed receiving the most appropriate therapy for their needs. The time required to complete this assessment added a significant workload to staff assignments (15 to 30 minutes per CPA), and it was unclear as to what the impact on patient care and workload would be. There were two possibilities: 1. Workload would remain the same (or even rise) based solely on the addition of the CPA, and might negatively impact patient care based on the increased time spent performing the CPA, or, 2. Workload would decrease based on the specificity of orders more suitably tailored to each patient's needs, thereby enhancing the level of patient care. Our hypothesis was that there should be a decrease in overall workload with a concurrent rise in CPA as patients had their care plans tailored by therapist's recommendations; this would be an indicator of a positive effect on patient care.

Methodology: A retrospective data analysis for a uniform time period for both the current and previous years. The data collection period and analysis being reported include 90 days of data post advent of the CPA. Study and data collection are ongoing at this time. Data sets include workload statistics which are referred to as Relative Value Units (RVU), and patient evaluations (both comprehensive and limited). The RVU is defined as a unit of time (10 minutes), and includes all procedures for which assessments ordered as defined by health system policy/procedure.

Results: Data collected for the first 90 days after initiating the CPA appears to support this hypothesis, with a 3% increase in total assessments performed and a 2% decrease in average workload from the period prior to the CPA. Data compared to the same time period of the previous year shows a 9% increase in workload (RVU) and a 23% increase in number of assessments. Adjusted Length of Stay (ALOS) data by DRG shows a 20% decrease in ALOS for those patients admitted with a Respiratory-based DRG, from 5.5 Days (2004) to 4.4 Days (2005) (see Table 1). There was a 14% increase in patient admissions within these DRG's from 2004 to 2005.

Conclusions: While the decrease in workload has not shown to be statistically significant (p< .05) at such an early point, the decrease in ALOS for those patients admitted with a Respiratory-based DRG is significant (p> .05), and represents a tangible dollar amount. Whether the decrease in ALOS is due solely to the CPA alone cannot be fully ascertained, but it has made a difference to the level and quality of patient care performed at this facility. Respiratory Care staff is becoming more proactive in the provision of care to their patients, tailoring the care plan to their patient's needs and interacting with Medical and Nursing Staff to ensure that the changes are made.

(Table 1)

ALOS by DRG 2004 2005 Delta (%)
Pneumonia 6.2 5.0 20.0%
CHF 3.1 3.0 4.3%
Asthma/Bronchitis 5.3 3.3 38.8%
Emphysema 5.2 4.7 12.5%
AVERAGES 5.5 4.4 20.0%
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