The Effect of Respiratory Therapist-Initiated Treatment Protocols on Patient Outcomes and Resource Utilization

The Scientific Basis for Protocol-Directed Respiratory Care

“…The study revealed that using respiratory-therapist-driven protocols (firm A) was associated with fewer RT treatments (10.7 for firm A vs 12.4 for firm B vs 12.3 for firm C, P ϭ .009), a greater percentage of bronchodilators administered via metered-dose inhaler (89% vs 77% vs 78%, P ϭ .01), fewer RT orders that were discordant with the protocol standard (24% vs 58% in firms B and C, risk 35 these benefits were achieved without any increase in adverse events. In summary, these 2 randomized controlled trials 35,36 (see Table 1) and the earlier observational studies [32][33][34] strongly satisfy both criteria to establish the scientific basis of respiratory care protocols. Specifically, respiratory therapists implementing protocol-based care benefit patients, and the use of such protocols enhances allocation and lowers cost, compared with traditional physiciandirected respiratory care.…”

“…Although physicians-in-training provided the intervention in this study, experience in other studies suggests that respiratory therapists can also be highly effective in this role. [30][31][32][33][34][35][36] Kallam et al 29 compared the prescribing patterns and associated costs with physician-directed care versus suggested RT-protocol-administered care. Protocols would have lessened the frequency of bronchodilator administration (eg, from 63.6% administered every 4 h to 11.3% administered every 4 h, P Ͻ .001) and the cost per patient ($10.3 Ϯ 9.4/patient vs $19.0 Ϯ 6.9/patient, P Ͻ .001).…”

“…Both trials compare the impact of in-patient respiratory care protocol services, versus usual physician-directed care, 35,36 and show that respiratorytherapist-directed care allows better allocation of respiratory care services than physician-directed care, with trends toward lower cost and no excess adverse events (Table).…”

Can Respiratory Therapist-Driven Protocols Improve Resource Utilization?

“…7 The goal of these protocols is to deliver effective and appropriate care to patients who would benefit from these treatments. 5,6 Moreover, when evidence is present for certain therapies, protocols help to eliminate the variability in delivery of care and may contribute to decreased healthcare cost.…”

“…[1][2][3][4][5][6] These studies have shown an improvement in cost and allocation of non-ICU patients when respiratory-therapy-protocol-based care was used. [1][2][3][4][5][6] Nevertheless, the effects of bronchodilator therapy as a single intervention using a respiratorytherapy protocol are less known.…”