Background: Respiratory treatment protocols have been found to minimize unnecessary bronchopulmonary hygiene therapies and allocate respiratory care services better than physician-directed care. At the University of Wisconsin Hospital , we implemented a Respiratory Assess and Treat Protocol program in 1999. When ordered by a physician, the protocol allows Respiratory Therapists to determine the most appropriate care for the patient based on criteria defined by an assessment tool with algorithms. The algorithms used define criteria for bronchodilator administration, secretion clearance, and volume expansion. The RT could initiate, modify, and discontinue treatment based on patient specific conditions and objective assessments. Physician compliance with the protocols was inconsistent with substantial variation amongst services.

Methods: Between January - June 2007 we implemented the following 3-pronged campaign to encourage the use of protocols:

1. The Respiratory Care Medical Director and Protocol Coordinator met with multiple physician and resident groups to present the RT protocol program.
2. All Respiratory Therapists were required to attend a protocol review session and complete case studies to demonstrate appropriate decision making and competency in use of the protocols.
3. Whenever an order was received for a treatment that fell within the scope of the protocols, the RT contacted the ordering provider and pursued an order for treatment via protocol.

We compared 6 months of protocol and treatment data prior to the protocol campaign to 6 months after full implementation. Data was obtained retrospectively from department productivity reports.

Results: SEE TABLE

Conclusion: Our 3-prong campaign resulted in a substantial increase in utilization of treatment protocols (↑146%), decrease in administration of medications (↓20%), and increase in non-medication treatments (↑ 7%).