A Volume Expansion Protocol: Using Incentive Spirometry as an Inspiratory Capacity Screening Tool Only

Abstract

Background:

Intermountain Medical Center is a 504-bed hospital and one of 23 acute care hospitals of the Intermountain Healthcare Corporation. Over the last few years, we have created and implemented an adult RT Evaluate and Treat (RET) program that includes over 20 evidence-based protocols. Physicians order RET, and RTs perform comprehensive and focused evaluations and begin the interventions for which the patient meets specifically defined criteria. A Lung Volume Expansion (LVE) Protocol is included. The LVE protocol utilizes an incentive spirometer (IS) as an inspiratory capacity (IC) screening tool. If a patient achieves less than one-third of their predicted IC, then other LVE strategies using positive airway pressure devices/maneuvers are employed (ie, EzPAP). The patient's ability and key goals of therapy are considered.

Methods:

During 2016 and 2017, 56,645 patients were evaluated for the LVE Protocol.

Results:

Outcomes of the evaluations are reported in Table One. It should be noted the small number that truly met the criteria for continued volume expansion maneuvers. In the past, almost all patients received an IS with an ordered frequency. Under the protocol, they are put to self-use and RTs are only called if the IC falls below one-third of predicted.

Conclusions:

With the accumulating evidence, initiatives to decrease wasteful spending of healthcare funds while assuring Respiratory Care (RC) resources are placed where most needed, our corporation sought to create protocolized care with the main goal of providing medically necessary interventions. Surgeons were our most resistant group to influence; however, reporting a review of the literature1, the reported outcomes and providing timely feedback regarding patient responses to interventions has improved 'buy in' from this subset of physicians. It is our conclusion that RC is in a unique position to provide high quality patient evaluations and apply evidence-based, medically necessary interventions to do the right thing in the right place at the right time. It is our impression that quality of patient care and our profession will be elevated.

1. Eltorai A, Szabo AL, Antoci V, Ventetuolo CE, Elias JA, Daniels AH, Hess DR. Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respir Care 2017;60(5):1-6.

Table One: Lung Volume Expansion Protocol Patient Inspiratory Capacity Evaluations n=56,645

IC > 1/3 of Predicted# (%)	IC < 1/3 Predicted# (%)
51,155 (90)	EzPAP®	Required Transfer into Secretion Mobilization Protocol
	3,032 (6)	2,458 (4)