2007 OPEN FORUM Abstracts
A COMPARISON OF INDICATIONS USED FOR RESPIRATORY CARE PROTOCOLS IN DIFFERENT HOSPITALS
E. L. Kester1, E. Hoisington1, J. K. Stoller1
Background: Respiratory care protocols aim to optimize allocation of respiratory care services. Ideally, protocols are based on the best available evidence which is shared across hospitals, thereby encouraging standard and optimal care across settings. To assess the degree of concordance between respiratory care protocols from different hospitals, we compared the indications for 5 respiratory care modalities in protocols from 7 different hospitals.
Methods: Managers from 7 hospitals known to use comprehensive respiratory care protocol programs were invited to submit protocols for comparison in this study. Indications for 5 respiratory care modalities (bronchodilator therapy, bronchopulmonary hygiene (bph), incentive spirometry (IS), supplemental oxygen, and pulse oximetry) were compared with regard to concordance among the 7 hospitals and use of Clinical Practice Guidelines (CPGs) of the American Association for Respiratory Care (AARC).
Results: The degree of agreement among the 7 hospitals’ protocols varied among the 5 modalities. Concordance was greatest among protocols regarding indications for IS and bronchodilator use. For bronchodilator use, though no AARC CPG was available, all 7 hospitals agreed on 4 indications, while1 hospital cited an additional indication. In contrast, agreement was poorest regarding indications for bph and oxygen. Four hospitals agreed with the first 3 of the CPG indications, while 4 hospitals used additional criteria. Regarding oxygen therapy, all hospitals used more lenient oxygenation criteria to prescribe oxygen than specified by the AARC CPG for home use and long term care. For pulse oximetry, 3 hospitalsâ protocols did not include indications for pulse oximetry while the remaining 4 hospitals used the CPG criteria.
Conclusions: In this sample of 7 hospitals’ respiratory care protocols, a large overall degree of discordance in the indications for 5 respiratory care modalities was apparent and was greatest for bronchopulmonary hygiene and oxygen use. Also, the degree to which hospitals adopted AARC Clinical Practice Guidelines as indications for therapy varied. These variations in the indications for therapy would be expected to produce different respiratory care plans for similar patients in the compared hospitals. These findings suggest the need for greater standardization of respiratory care protocols in order to realize the goal of CPGs to offer evidence-based respiratory care in a standard and uniform way.