Metcalf Ashley Y, Stoller James K, Fry Timothy D, Habermann Marco
College of Business, Ohio University, Athens, Ohio.
Education Institute and Respiratory Institute, Departments of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio.
Respir Care. 2015 May;60(5):636-43. doi: 10.4187/respcare.03699. Epub 2015 Jan 27.
Organizational factors associated with adoption and use of respiratory care protocols have received little attention. This study examines patterns of protocol use and features of a hospital and providers that are associated with respiratory care protocol use.
Forty-four hospitals and their health-care providers responded to an online survey regarding perceived outcomes of protocol use and their level of support for using protocols. Hospital features (ie, size, teaching status, and use of information systems) were also assessed. Descriptive statistics and multivariate logistic regression were used for analysis.
Of the 9 types of respiratory care protocols assessed (ie, asthma, COPD, ARDS, hypoxemia, pneumonia, noninvasive ventilation therapy, supplemental oxygen titration and discontinuation, ventilator weaning, and bronchopulmonary hygiene), the most commonly used were for oxygen titration and ventilator weaning. Large hospitals (> 350 beds) used protocols more widely than smaller hospitals (P = .01). Respondents felt that use of protocols enhanced cost and quality of care. Finally, hospital features that were associated with overall protocol use were stakeholder support for protocol use and use of high-quality hospital information systems.
The study extends prior research by clarifying features of hospitals and providers associated with use of respiratory care protocols. Validation in future hypothesis-testing samples will further advance this knowledge.
与呼吸护理协议的采用和使用相关的组织因素很少受到关注。本研究调查了协议使用模式以及与呼吸护理协议使用相关的医院和医护人员的特征。
44家医院及其医护人员对一项在线调查做出了回应，该调查涉及协议使用的预期结果以及他们对使用协议的支持程度。还评估了医院特征（即规模、教学地位和信息系统的使用情况）。采用描述性统计和多变量逻辑回归进行分析。
在评估的9种呼吸护理协议类型（即哮喘、慢性阻塞性肺疾病、急性呼吸窘迫综合征、低氧血症、肺炎、无创通气治疗、补充氧气滴定和停用、呼吸机撤机以及支气管肺卫生）中，最常用的是氧气滴定和呼吸机撤机协议。大型医院（>350张床位）比小型医院更广泛地使用协议（P = 0.01）。受访者认为使用协议提高了护理成本和质量。最后，与总体协议使用相关的医院特征是利益相关者对协议使用的支持以及高质量医院信息系统的使用。
本研究通过阐明与呼吸护理协议使用相关的医院和医护人员的特征，扩展了先前的研究。在未来的假设检验样本中进行验证将进一步推进这方面的知识。
