The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

DEVELOPMENT OF A 72 HOUR ASSESSMENT PROGRAM TO FACILITATE NON-CONCURRENT THERAPY

B. Green1, R. Wolff1, K. D. Hargett1, P. Turner1, M. Ewah1, B. Wenger1


Background: The AARC White Paper on concurrent therapy led our institution to adopt a practice of no concurrent therapy. This led to an increase in the number of missed therapies due to the additional time spent with each patient. A performance improvement project evaluated 1000 patients and indicated that 67% of patients not followed by pulmonary consult did not have appropriate indications for therapy. A 72 hour assessment program was created to evaluate the appropriateness of therapy and to discontinuing therapy that was not indicated. We identified all patients that had received respiratory therapy for 72 hours. We performed a detail assessment to identify the appropriateness of the therapy. We either discontinued or changed to a more appropriate therapy.

Methods:
Our Respiratory Care Management Information System would identify any patient on therapy for 72 hours. A team of therapists were trained to identify the pulmonary consult patient population and then perform the assessment. An assessment process was clearly defined and included history, breath sounds, x-ray, cough, secretions, inspiratory effort, breathing pattern, and oxygen requirements. When the assessment revealed the patient did not need therapy it was automatically discontinued, if the patient was not followed by a pulmonary consult. When the assessment revealed the patient needed to continue or change therapy the physician was notified, whether or not the patient was managed by a pulmonary consult.

Results:
Data collected was evaluated to separate the pulmonary consult from the non-pulmonary consult, to identify the percent of therapy discontinued on patients that were not followed by a pulmonary consult, and the percent of therapies adjusted on all patients. The table shows quarterly averages for the year 2006.

Conclusion:
Standardized assessment programs are a safe and effective way to identify appropriateness of therapy and to shape the demands for services. A 72 hour assessment program resulted in an increasing percentage of therapy being discontinued and a decrease in the number of adjustments made to inappropriate therapies. We believe constant communication with physicians stimulated more appropriate ordering regimens requiring fewer adjustments in therapy. The data also showed a decrease in the pulmonary consults. Further study is necessary to determine if there is a correlation between therapy discontinued and pulmonary consults.

  Jan-Mar06 Apr-Jun06 Jul-Sept06 Oct-Dec06
Patients Evaluated 1071 1024 1084 1046
Therapy discontinued (non pulmonary consult) 73%
429/588
84%
438/522
86%
531/618
88%
534/609
Therapy Adjusted (of total) 30%
321
30%
307
15%
163
23%
241
Pulmonary Consults 54%
493
49%
502
43%
466
42%
439



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