Kester L, Stoller J K
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195.
Cleve Clin J Med. 1992 Nov-Dec;59(6):581-5. doi: 10.3949/ccjm.59.6.581.
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.
由于近期对呼吸护理服务分配不当的担忧，且有分析表明，按照既定指南限制服务可减少不必要的治疗，同时不影响护理质量，作者对克利夫兰诊所基金会新接受至少五种呼吸治疗（氧气治疗、激励性肺量计、支气管肺卫生、雾化支气管扩张剂治疗或间歇性正压通气）之一的170例患者的记录进行了审计。在审查所订购的治疗是否符合这些服务的已发表指南时，我们发现25.2%的治疗“不适用”。这种过度订购产生了11,937美元的不必要总费用（每位患者206.16美元），占用了治疗师的时间，而这些时间本可更好地分配到其他服务上。这些费用因发现10.5%的患者未被订购接受适用的呼吸治疗而得到抵消。我们提出的启动呼吸护理服务订购和提供方案（即通过呼吸护理咨询服务）的策略是解决这种分配不当问题的一种有吸引力的方法，但需要进一步评估。
