Zibrak J D, Rossetti P, Wood E
N Engl J Med. 1986 Jul 31;315(5):292-5. doi: 10.1056/NEJM198607313150505.
In 1981-1982, a Massachusetts Hospital Association and Massachusetts Blue Cross-Blue Shield task force reviewing ancillary services found that the use of respiratory therapy at New England Deaconess Hospital far exceeded the statewide average. These findings led to a hospital-wide effort to reduce ancillary services. As part of this effort, we studied the effect of the reductions in respiratory therapy on patient outcome. At the beginning of the study, senior respiratory therapists advised physicians about the optimal use of various respiratory-therapy services, including their discontinuation when no longer necessary. One year after the intervention began, we analyzed the use of respiratory therapy by employing data-collection techniques that were identical to those used by the task force. Marked reductions in all categories of respiratory therapy had occurred, but morbidity and mortality from pulmonary disorders had not increased. In the largest group studied--patients undergoing coronary-artery bypass surgery--the charges for respiratory therapy, the length of hospital stay, and pulmonary complications had all decreased. We conclude that consistent application of prescribed guidelines for respiratory therapy results in marked decreases in its use and that such decreases can be achieved without a reduction in the quality of care.
1981年至1982年期间，马萨诸塞州医院协会和马萨诸塞州蓝十字蓝盾公司的一个特别工作组在审查辅助服务时发现，新英格兰女执事医院的呼吸治疗使用量远远超过全州平均水平。这些发现促使全院努力减少辅助服务。作为这项工作的一部分，我们研究了减少呼吸治疗对患者预后的影响。在研究开始时，资深呼吸治疗师就各种呼吸治疗服务的最佳使用方法向医生提供建议，包括在不再需要时停止使用这些服务。干预开始一年后，我们采用了与特别工作组相同的数据收集技术来分析呼吸治疗的使用情况。所有类别的呼吸治疗都有显著减少，但肺部疾病的发病率和死亡率并未增加。在研究的最大一组患者——接受冠状动脉搭桥手术的患者中，呼吸治疗费用、住院时间和肺部并发症均有所下降。我们得出结论，持续应用规定的呼吸治疗指南会导致其使用量显著减少，并且可以在不降低护理质量的情况下实现这种减少。
