The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Earl Fulcher, Cindy Sparkman, Boaz Markewitz, Mickey Roach; Respiratory Therapy, University of Utah Health Care, Salt Lake City, UT

Background: Therapist driven protocols (TDPs) have been demonstrated to reduce misallocation of respiratory therapy and cost of care. In limited patient populations, TDPs have proven to reduce hospital length of stay and ICU length of stay. We implemented airway clearance (AWC), lung volume expansion (LVE), and bronchodilator (BD) protocols in 2008 and monitored the effect on various patient outcomes through December 2011. Methods: The protocols were approved by our institution for use on all adult inpatients, except those diagnosed with Cystic Fibrosis (CF) or those who were post lung transplant. For the first 24 hours after a provider’s order, therapy was administered based on the original provider’s order unless an “assess and treat” order was input by the provider. After the first 24 hours of therapy or within 4 hours of receipt of an assess and treat order, a specially trained therapist performed a protocol assessment. The protocol assessment and algorithms were programmed into branching logic software which drives protocol decisions. Several new therapy procedures were offered in the post protocol phase including high frequency chest wall compression, mechanical insufflation-exsufflation, CPAP Hyperinflation therapy, and use of a breath actuated nebulizer. Results: Pre and post protocol outcome measurements included hospital length of stay (LOS), ICU LOS, Ventilator Days, and average number of treatments received per patient. Pre-protocol patients (n = 1051) included any non-CF or non-lung transplant patients who received short acting bronchodilator, airway clearance, or lung volume expansion therapy during the two years prior to protocol implementation. Post protocol (n = 3,452) patients demonstrated a significant reduction in LOS (21.3 +/- 20.4 vs 16.4 +/- 16.2 days, P < 0.0001), ICU LOS (12.4 +/- 15.5 vs 9.4 +/- 12.8 days, P < 0.0001), and ventilator days (10.1 +/- 11.0 vs 8.3 +/- 10.3 days, P < 0.0001) while the average number of treatments per patient was unchanged for both AWC/LVE ( 24.2 +/- 26.3 vs 24.6 +/- 31.5 therapies, P 0.74) and BD protocols (37.4 +/- 49.5 vs 37.6 +/- 56.0 therapies, P 0.92 ). Conclusion: Therapist driven protocols at our institution directed via branching logic software produced a significant improvement in patient outcomes while providing a similar number of treatments per patient when compared with physician directed care. Sponsored Research - None