The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

UPDATED RESPIRATORY CARE PROTOCOL IMPROVES UTILIZATION AND DECREASES COST

Damien P. Beilman, Debra Fox; Respiratory Care, Wesly Medical Center, Wichita, KS

Introduction: The Respiratory Care Department of a 760 bed tertiary acute care referral center instituted a hospital wide application of respiratory care protocol to provide optimal care and decrease costs. The previous respiratory protocol system was updated utilizing the evidence-based guidelines outlined in the Global Initiative for Chronic Lung Disease (GOLD). This updated protocol system utilized a dichotomy that differentiated between patients admitted with underlying chronic obstructive lung disease (COPD) and those with non-COPD pathology and was approved by the medical center’s Medical Executive Committee. The objective was to decrease unnecessary utilization, length of stay, cost of care and the use of levalbuterol and ipratropium bromide. Method: This study evaluated average utilization, length of stay and pharmacy inventory costs before (January 2006-April 2008) and after (May 2008-December 2008) implementation of the updated protocol. Results: Table 1 shows the pre and post utilization data. It was expected that MDI administration would increase as respiratory therapists assumed delivery of a medication modality that had been traditionally given by nursing. Medication nebulizer and lung expansion therapy decreased by 16% and 11%, respectively. The length of stay for COPD, asthma/bronchitis and major chest trauma decreased an average of 1.01, 2.7 and 2.3 days, respectively. Increase in the utilization of secretion clearance is directly attributable to patient administered use of the Acapella secretion device that was included in the updated protocol system. Decreased use of levalbuterol and ipratropium during the six month trial resulted in a cost savings of $5,456.64. Pharmacy inventory costs for metered dose inhalers decreased $40,000 per month with implementation of a common canister process. Conclusion: Our data suggests that evidence-based respiratory care protocols that differentiate between patients with COPD and non-COPD pathology are associated with a decrease in resource utilization, length of stay and pharmacy costs. This study did not evaluate quality patient outcomes or appropriateness of care. Further evaluations are necessary to determine that this protocol model improves patient outcomes. Sponsored Research - None

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