Dailey Robert T, Malinowski Thomas, Baugher Mitchel, Rowley Daniel D
Department of Pulmonary Diagnostics and Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, Virginia.
Respir Care. 2017 May;62(5):517-523. doi: 10.4187/respcare.05269. Epub 2017 Feb 21.
The purpose of this retrospective medical record review was to report on recidivism to the ICU among adult postoperative cardiac and thoracic patients managed with a respiratory therapy assess-and-treat (RTAT) protocol. Our primary null hypothesis was that there would be no difference in all-cause unexpected readmissions and escalations between the RTAT group and the physician-ordered respiratory care group. Our secondary null hypothesis was that there would be no difference in primary respiratory-related readmissions, ICU length of stay, or hospital length of stay.
We reviewed 1,400 medical records of cardiac and thoracic postoperative subjects between January 2015 and October 2016. The RTAT is driven by a standardized patient assessment tool, which is completed by a registered respiratory therapist. The tool develops a respiratory severity score for each patient and directs interventions for bronchial hygiene, aerosol therapy, and lung inflation therapy based on an algorithm. The protocol period commenced on December 1, 2015, and continued through October 2016. Data relative to unplanned admissions to the ICU for all causes as well as respiratory-related causes were evaluated.
There was a statistically significant difference in the all-cause unplanned ICU admission rate between the RTAT (5.8% [95% CI 4.3-7.9]) and the physician-ordered respiratory care (8.8% [95% CI 6.9-11.1]) groups ( = .034). There was no statistically significant difference in respiratory-related unplanned ICU admissions with RTAT (36% [95% CI 22.7-51.6]) compared with the physician-ordered respiratory care (53% [95% CI 41.1-64.8]) group ( = .09). The RTAT protocol group spent 1 d less in the ICU ( < .001) and in the hospital ( < .001).
RTAT protocol implementation demonstrated a statistically significant reduction in all-cause ICU readmissions. The reduction in respiratory-related ICU readmissions did not reach statistical significance.
本回顾性病历审查的目的是报告采用呼吸治疗评估与治疗（RTAT）方案管理的成人心脏和胸科术后患者再次入住重症监护病房（ICU）的情况。我们的主要无效假设是，RTAT组与医生医嘱呼吸护理组在全因意外再入院和病情升级方面没有差异。我们的次要无效假设是，在原发性呼吸相关再入院、ICU住院时间或医院住院时间方面没有差异。
我们回顾了2015年1月至2016年10月期间1400例心脏和胸科术后患者的病历。RTAT由标准化的患者评估工具驱动，该工具由注册呼吸治疗师完成。该工具为每位患者制定呼吸严重程度评分，并根据算法指导支气管卫生、雾化治疗和肺膨胀治疗的干预措施。方案期从2015年12月1日开始，持续到2016年10月。评估了与所有原因以及呼吸相关原因导致的非计划入住ICU相关的数据。
RTAT组（5.8%[95%CI 4.3 - 7.9]）和医生医嘱呼吸护理组（8.8%[95%CI 6.9 - 11.1]）的全因非计划ICU入住率存在统计学显著差异（P = 0.034）。与医生医嘱呼吸护理组（53%[95%CI 41.1 - 64.8]）相比，RTAT组呼吸相关非计划ICU入住率无统计学显著差异（36%[95%CI 22.7 - 51.6]）（P = 0.09）。RTAT方案组在ICU（P < 0.001）和医院（P < 0.001）的住院时间少1天。
RTAT方案的实施显示全因ICU再入院率有统计学显著降低。呼吸相关ICU再入院率的降低未达到统计学显著性。
