BACKGROUND: Respiratory therapist (RT) driven protocols decrease ventilator days and resource utilization in the intensive care unit (ICU). Protocols have been studied in non-ICU settings, but their effect on mortality has been incompletely studied. METHODS: In our neurosurgery step-down, trauma/surgery step-down, and trauma/surgery general units we initiated an RT-driven evaluate-and-treat protocol that included a standardized, quantitative, RT-driven patient-assessment scale and protocolized interventions. Before and after initiation of the protocol we collected data on non-ICU patients at risk for pulmonary complications. RESULTS: The patient groups before (n = 2,230) and after (n = 2,805) protocol initiation were well matched in age, sex, Charlson score, and admitting service. Most of the patients, whether assessed by a physician or an RT, were deemed to have low risk of pulmonary complications and did not require any respiratory treatments. The number of respiratory treatments increased after protocol initiation, but the patients who received respiratory treatments after protocol initiation had shorter ICU stay and hospital stay, and lower total hospital costs than those who received respiratory treatments before protocol initiation. There was a nonsignificant trend toward lower mortality after protocol initiation. CONCLUSIONS: Our RT-evaluate-and-treat protocol for non-ICU surgery patients was associated with more patients receiving respiratory treatments but decreased ICU and hospital stay and lower total hospital costs. Routine RT-driven assessment of non-ICU patients may reduce pulmonary complications in high-risk patients.
BACKGROUND: Respiratory therapist (RT) driven protocols decrease ventilator days and resource utilization in the intensive care unit (ICU). Protocols have been studied in non-ICU settings, but their effect on mortality has been incompletely studied. METHODS: In our neurosurgery step-down, trauma/surgery step-down, and trauma/surgery general units we initiated an RT-driven evaluate-and-treat protocol that included a standardized, quantitative, RT-driven patient-assessment scale and protocolized interventions. Before and after initiation of the protocol we collected data on non-ICU patients at risk for pulmonary complications. RESULTS: The patient groups before (n = 2,230) and after (n = 2,805) protocol initiation were well matched in age, sex, Charlson score, and admitting service. Most of the patients, whether assessed by a physician or an RT, were deemed to have low risk of pulmonary complications and did not require any respiratory treatments. The number of respiratory treatments increased after protocol initiation, but the patients who received respiratory treatments after protocol initiation had shorter ICU stay and hospital stay, and lower total hospital costs than those who received respiratory treatments before protocol initiation. There was a nonsignificant trend toward lower mortality after protocol initiation. CONCLUSIONS: Our RT-evaluate-and-treat protocol for non-ICU surgery patients was associated with more patients receiving respiratory treatments but decreased ICU and hospital stay and lower total hospital costs. Routine RT-driven assessment of non-ICU patients may reduce pulmonary complications in high-risk patients.
Authors: Ruth Kleinpell; W Robert Grabenkort; Walter A Boyle; David L Vines; Keith M Olsen Journal: Crit Care Med Date: 2021-12-01 Impact factor: 9.296