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Contributions

Ordering respiratory care services for hospitalized patients: practices of overuse and underuse

Lucy Kester, RRT, MBA and James K. Stoller, MD
Cleveland Clinic Journal of Medicine November 1992, 59 (6) 581-585;
Lucy Kester
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James K. Stoller
Section of Respiratory Therapy, Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation.
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ABSTRACT

Because of recent concerns about misallocation of respiratory care services and analyses suggesting that limiting services to comply with established guidelines reduces unneeded therapies without compromising quality of care, the authors audited the records of 170 patients newly ordered to receive at least one of five respiratory therapies (oxygen therapy, incentive spirometry, bronchopulmonary hygiene, aerosolized bronchodilator therapy, or intermittent positive pressure breathing) at The Cleveland Clinic Foundation. In reviewing whether the therapies that were ordered complied with published guidelines for these services, we found that 25.2% were "not indicated." This over-ordering incurred unnecessary total charges of $11,937 ($206.16 per patient) and occupied therapist time that could have been better allocated to other services. These costs were offset by the finding that 10.5% of the patients were not ordered to receive indicated respiratory therapies. Our proposed strategy of initiating protocols for ordering and providing respiratory care services (ie, via a respiratory care consult service) is an appealing means to address this misallocation, but it requires further evaluation.

INDEX TERMS
  • Respiration
  • Artificial
  • Utilization Review
  • Copyright © 1992 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 59 (6)
Cleveland Clinic Journal of Medicine
Vol. 59, Issue 6
1 Nov 1992
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Ordering respiratory care services for hospitalized patients: practices of overuse and underuse
Lucy Kester, James K. Stoller
Cleveland Clinic Journal of Medicine Nov 1992, 59 (6) 581-585;

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Ordering respiratory care services for hospitalized patients: practices of overuse and underuse
Lucy Kester, James K. Stoller
Cleveland Clinic Journal of Medicine Nov 1992, 59 (6) 581-585;
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Keywords

  • Respiration
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