Monitoring Quality in A Respiratory Care Protocol Service: Methods and Outcomes

Abstract

Background

A respiratory therapy consult service (RTCS) was initiated at The Cleveland Clinic Foundation in 1992, and has directed respiratory care for most adult non-ICU inpatients since December 1994. In 1996 an audit system was initiated to study the timeliness and appropriateness of the respiratory care plans being written and implemented.

Methods

Two care plans per week were audited by the education coordinator. The auditor's assessment is conducted within 24 hours of the therapist's initial assessment, and without knowledge of the therapist's assessment or care plan. These independently-created assessments were compared, and feedback was provided to the therapist. Audit results were presented and discussed quarterly during respiratory therapy section administrative meetings, and were posted for review by respiratory care staff.

Results

During the first 8 quarters of the audit system, agreement on assessment items and respiratory care modalities was consistently high, though with greater agreement on respiratory care modalities than assessment items. The percentage of agreement on care plans improved during the first 8 quarters. Adjustments designed to minimize the subjectivity of certain assessment categories improved the percentage of agreement in assessments.

Conclusions

An audit system can help improve the accuracy and timeliness of a respiratory care protocol service, serve as an educational tool, and promote therapists' best efforts.