Stoller J K, Haney D, Burkhart J, Fergus L, Giles D, Hoisington E, Kester L, Komara J, McCarthy K, McCann B
Cleveland Clinic Foundation, OH 44195.
Respir Care. 1993 Nov;38(11):1143-54.
Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation.
The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients). In the pilot study, Therapist Evaluators responded to requests for Consults on two study wards. All staff therapists participated in implementing Evaluator-determined treatment.
We evaluated 38 patients (20 of whom were Consult patients) randomly selected from a total of 82 patients undergoing abdominal surgery during the study period.
Consult patients were significantly older than non-Consult patients, more likely to be heavy smokers (67 vs 43%), and sicker as suggested by a higher Triage Score. Consult patients received more types and more total respiratory care services, demonstrated a trend toward longer stay, and had significantly higher respiratory therapy charges.
Our experience shows that a consult program can be successfully implemented in a large, tertiary care institution with widespread physician and nursing support. Whether the RTCS fulfills its goal of ameliorating misallocation of respiratory care has yet to be proven and awaits the completion of other studies currently under way.
越来越多的证据表明，呼吸护理常常分配不当。我们报告了一项旨在纠正这种分配不当的输送系统试点研究的结果。
该输送系统（呼吸治疗咨询服务，即RTCS）允许呼吸治疗师（应病例管理医生的要求）确定呼吸护理，决策由算法指导（即咨询患者）。在试点研究中，治疗师评估员对两个研究病房的咨询请求做出回应。所有在职治疗师都参与实施评估员确定的治疗。
我们从研究期间接受腹部手术的82名患者中随机选取了38名患者（其中20名是咨询患者）进行评估。
咨询患者明显比非咨询患者年龄大，更有可能是重度吸烟者（67%对43%），并且根据更高的分诊评分显示病情更严重。咨询患者接受了更多种类和更多的总体呼吸护理服务，住院时间有延长的趋势，呼吸治疗费用也明显更高。
我们的经验表明，在广泛的医生和护士支持下，咨询项目可以在大型三级医疗机构中成功实施。RTCS是否实现了改善呼吸护理分配不当的目标还有待证明，这有待目前正在进行的其他研究完成。
