In the 1970s the demand in our hospital for bronchial hygiene therapy (aerosols, IPPB, incentive spirometry, chest physical therapy) had increased to such a level that 20-30% of the ordered therapy was not being administered. Because the respiratory therapists and medical directors were convinced that much of the ordered therapy was unnecessary, the Respiratory Therapy Department began a program in 1978 in which specially trained respiratory therapists were authorized to evaluate all non-intensive-care patients for whom bronchial hygiene therapy had been ordered. The program protocol consists of a medical record review, a physical assessment of the patient, the development of a patient-care plan, and a re-evaluation every 2-3 days of the patient's continued need for therapy. We found that initiation of the program has led to improved documentation of the need for bronchial hygiene therapy and a significant decrease in total procedures performed, not merely a substitution of therapies. After being adjusted to the 1981 Consumer Price Index (CPI), total charges for bronchial hygiene therapy were markedly decreased even though hospital charges increased 77.4% above the CPI inflation rate. Since the program was begun, the respiratory therapy staff has been able to administer all ordered respiratory care services to patients in a critical care setting and not less than 90% of ordered bronchial hygiene therapy to patients outside the intensive care unit. House staff, attending physicians, and patients and their families appear to be satisfied with the therapist-evaluators, and the morale of respiratory therapists seems to have improved as a result of their being able to take a more active role in the treatment of their patients and to apply their skills to the patients most in need of them.
