Abstract
Background:
RT-driven airway clearance protocols have been shown to be safe and cost-effective, leading to decrease in treatment burdens and length of stay (LOS) without an increase in significant events (rapid response, code blue, ICU transfer) or readmission rates. The American College of Chest Physicians also supports the use of protocols to provide timely, safe, and cost-effective therapies. We aimed to evaluate the effectiveness of an airway clearance protocol for pediatric patients.
Methods:
The respiratory care department developed and implemented a Respiratory Therapist (RT) driven airway clearance protocol in Spring of 2020. After IRB approval, a retrospective chart review was completed comparing patients with hospital admissions both prior to and after implementation of the RT-driven protocol. Patients with an admission diagnosis of respiratory distress, breathing problem or respiratory-related infection were included in the review. Variables for analysis included hospital length of stay (HLOS), significant events (SE) and readmission rate (RA).
Results:
Fifteen patients were identified who had at least one admission prior to and after implementation of RT-driven airway clearance protocol. Of these patients, 53% were female (n = 8) and 47% male (n = 7). Ten patients used positive pressure ventilation at baseline, 27% artificial airway/invasive ventilation (n = 4) and 40% noninvasive ventilation (n = 6). After implementation, RTs utilized protocol autonomy to adjust orders at 25 different occurrences for the 15 patients included in the study analysis. HLOS decreased from 15.24 days to 9.9 days (P = .166). SE were unchanged pre- and post- airway clearance protocol implementation. There was a decrease in 30-day RA (Pre = 4; Post = 2) and respiratory-related RA (Pre-1; Post-0).
Conclusions:
Implementation of an RT-driven airway clearance protocol has resulted in decrease in HLOS without an increase in SE or readmission rates. Due to the small sample size, driven by COVID-19, the decrease in HLOS was not considered statistically significant. Further research should be done to evaluate statistical significance with larger sample size.
Table 1. Summary data pre-and post-implementation of RT-driven airway clearance protocol. View all access options for this article.
Pre- RT Protocol
Post-Implementation RT-Protocol
Average HLOS-Days (min-max) (p-value 0.166)
15.24 (1.8-54.4)
9.9 (3.8-66.1)
ICU Admission
3
2
Significant Events
2
2
Readmissions (within 30 days) *Non-respiratory related readmissions
1 (3*)
0 (2*)
Artificial Airway/Positive Pressure Ventilation
4
4
Non-Invasive Ventilation
6
6
Airway Clearance Therapies
Albuterol
15 (100%)
15 (100%)
Hypertonic Saline 3%
12 (80%)
12 (80%)
Atrovent
3 (20%)
3 (20%)
HFCWO
7 (47%)
9 (60%)
Insufflation/Exsufflation
4 (27%)
4 (27%)
IPV
4 (27%)
2 (13%)
Chest Physiotherapy
5 (13%)
2 (33%)
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