Abstract
BACKGROUND:
A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or under-ordering (ie, therapy indicated but not ordered). The rate of agreement with RTCS-based orders is defined as the percentage of patients with no misallocation. This study was undertaken to compare current misallocation and agreement with historical benchmark rates at a hospital with an RTCS (ie, the Main Campus, or “on-MC”) and 2 hospitals that did not have an RTCS (ie, off-Main Campus, or “off-MC”).
METHODS:
After approval by the institutional review board, data were collected during normal rounds. A respiratory therapist (RT) determined if the patient had an order for RTCS, what their treatments were, and whether treatment indications were present. RTCS treatments included aerosol therapy, bronchopulmonary hygiene, re-inflation, supplemental oxygen, oxygen monitoring, and suctioning. Agreement and misallocation were compared with chi-square or z-tests with
RESULTS:
The agreement rate for the RTCS on-MC was less than the benchmark rate established 20 years ago (63% vs 86%,
CONCLUSIONS:
While the overall rate of agreement was lower with the RTCS currently than in the past, the decline seems solely attributable to a decline in the appropriateness of orders for bronchopulmonary hygiene. In addition, the rate of agreement for non-RTCS-based orders on-MC (71%), where the RTCS has been available for over 20 years, was higher than agreement rate for non-RTCS-based therapies off-MC (20%), where the RTCS has not yet been available. These findings suggest continued efficacy of the RTCS with the need for ongoing vigilance to assure optimal RTCS performance.
Keywords
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