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Abstract

BACKGROUND: Due to the success of a respiratory care assessment-treatment pilot study on the orthopedic floor of our hospital, the Executive Committee of the medical staff approved expansion hospitalwide. EXPANSION TECHNIQUE: Each nursing unit was included in the project in a systematic fashion after group and individual communication had occurred. Patient assessment training sessions were conducted for the respiratory staff to allow for 24-hour coverage of all nursing units. EVALUATION METHODS: The evaluation period extended from October 1993 through October 1995. Daily monitoring activities tracked general data elements on all patients. A series of retrospective audits were conducted on a subset of patients to track a more detailed set of data points. The utilization and costs of respiratory services provided to patients in 20 selected DRGs were compared between a preprotocol period (April, May, and June 1993) and the same 3-month period in 1995. EVALUATION RESULTS: During the 2-year evaluation, daily monitoring revealed that 4,420 patients were assessed and treated by respiratory care practitioners (RCPs), which included 11,050 initial and follow-up evaluations. Retrospective audits on 595 of those patients indicated that participation in the protocol process increased significantly from 66% to 78% (p = 0.004). Of the patients on protocols, 81-88% were being tapered, placed on treat-as-needed status (ie, prn), discontinued, or readjusted to their home regimen prior to discharge. Physicians accepted the RCPs’ treatment plan 90-97% of the time without intervening. Treatment volume decreased, resulting in identified cost savings of $15,337 over a 3-month evaluation period (annualized savings, $61,348). CONCLUSIONS: The positive results of a respiratory patient assessment-treatment pilot project were successfully duplicated when the process was expanded hospitalwide. RCPs in our hospital were able to demonstrate value by implementing care plans that resulted in cost savings.

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A Respiratory Care Assessment-Treatment Program: Results of A Retrospective Study

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