PHYSICIAN-ORDERED RESPIRATORY CARE VS PHYSICIAN-ORDERED USE OF A RESPIRATORY THERAPY CONSULT SERVICE - RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY

Objective: To assess the impact of a respiratory therapy consult servi ce (RTCS) on practices and appropriateness of ordering respiratory car e services Design: Nonrandomized prospective observational cohort stud y with concurrent controls. Setting: Adult non-ICU inpatient wards of an academic medical center. Patients: A convenience sample of 98 adult non-ICU inpatients at the Cleveland Clinic Hospital, representing 20 inpatient clinical services, Patients whose respiratory care plans wer e determined by respiratory care practitioners using sign and symptom- based algorithms to specify treatment comprised the treatment group (n =51, respiratory therapy consult group), The nonconsult group (n=47) w ere patients whose respiratory care plans were specified by their own physicians. Intervention: Specification of the respiratory care plan b y the RTCS vs by the physicians themselves. Use of the RTCS was at the discretion of the managing physician. Outcome measures: Types and num ber of respiratory care treatments, length of hospital stay, costs of the respiratory therapy provided, appropriateness of respiratory care orders (based on comparison of the actual respiratory care orders with a reference respiratory care plan generated by a study investigator w ho was kept blind to the actual respiratory care plan), and adverse re spiratory events. Results: Patients for whom the RTCS was requested by their physicians had a greater severity of respiratory illness based on having a lower triage score, but were otherwise similar at baseline , Fewer initial orders for respiratory care were discordant with the r eference algorithms in RTCS patients (15%+/-26% [SD]) than in nonconsu lt patients (43%+/-36%; p<0.001), and a smaller fraction of RTCS patie nts received at least one discordant initial respiratory care order (3 7% vs 72%; p<0.001), Though provided to sicker patients with longer le ngths of hospital stay, RTCS-directed care incurred similar respirator y care costs per patient ($335.63+/-$272.69 [RTCS] vs $349.06+/-$273.2 7; p=0.72). Conclusions: These results suggest that the RTCS can be an effective strategy to allocate respiratory care strategies appropriat ely while conserving the costs of providing respiratory care.