Stoller J K, Skibinski C I, Giles D K, Kester E L, Haney D J
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Chest. 1996 Aug;110(2):422-9. doi: 10.1378/chest.110.2.422.
To assess the impact of a respiratory therapy consult service (RTCS) on practices and appropriateness of ordering respiratory care services.
Nonrandomized prospective observational cohort study with concurrent controls.
Adult non-ICU inpatient wards of an academic medical center.
A convenience sample of 98 adult non-ICU inpatients at the Cleveland Clinic Hospital, representing 20 inpatient clinical services. Patients whose respiratory care plans were determined by respiratory care practitioners using sign and symptom-based algorithms to specify treatment comprised the treatment group (n = 51, respiratory therapy consult group). The nonconsult group (n = 47) were patients whose respiratory care plans were specified by their own physicians.
Specification of the respiratory care plan by the RTCS vs by the physicians themselves. Use of the RTCS was at the discretion of the managing physician.
Types and number of respiratory care treatments, length of hospital stay, costs of the respiratory therapy provided, appropriateness of respiratory care orders (based on comparison of the actual respiratory care orders with a reference respiratory care plan generated by a study investigator who was kept blind to the actual respiratory care plan), and adverse respiratory events.
Patients for whom the RTCS was requested by their physicians had a greater severity of respiratory illness based on having a lower triage score, but were otherwise similar at baseline. Fewer initial orders for respiratory care were discordant with the reference algorithms in RTCS patients (15% +/- 26% [SD]) than in nonconsult patients (43% +/- 36%; p < 0.001), and a smaller fraction of RTCS patients received at least one discordant initial respiratory care order (37% vs 72%; p < 0.001). Though provided to sicker patients with longer lengths of hospital stay, RTCS-directed care incurred similar respiratory care costs per patient ($335.63 +/- $272.69 [RTCS] vs $349.06 +/- $273.27; p = 0.72).
These results suggest that the RTCS can be an effective strategy to allocate respiratory care strategies appropriately while conserving the costs of providing respiratory care.
评估呼吸治疗咨询服务（RTCS）对呼吸护理服务的操作及医嘱合理性的影响。
设有同期对照的非随机前瞻性观察队列研究。
一所学术医疗中心的成人非重症监护病房。
克利夫兰诊所医院98名成人非重症监护住院患者的便利样本，代表20个住院临床科室。其呼吸护理计划由呼吸治疗从业者根据体征和症状算法确定治疗方案的患者组成治疗组（n = 51，呼吸治疗咨询组）。非咨询组（n = 47）是由其自身医生确定呼吸护理计划的患者。
由RTCS而非医生本人确定呼吸护理计划。RTCS的使用由主治医生自行决定。
呼吸护理治疗的类型和次数、住院时间、所提供呼吸治疗的费用、呼吸护理医嘱的合理性（基于将实际呼吸护理医嘱与由对实际呼吸护理计划不知情的研究调查员生成的参考呼吸护理计划进行比较）以及不良呼吸事件。
因医生要求接受RTCS的患者，基于较低的分诊评分，其呼吸疾病严重程度更高，但在基线时其他方面相似。与非咨询患者（43% ± 36%）相比，RTCS患者中与参考算法不一致的初始呼吸护理医嘱较少（15% ± 26% [标准差]；p < 0.001），且接受至少一项不一致初始呼吸护理医嘱的RTCS患者比例更小（37% 对 72%；p < 0.001）。尽管RTCS针对的是病情更重、住院时间更长的患者，但RTCS指导的护理每位患者产生的呼吸护理费用相似（335.63美元 ± 272.69美元 [RTCS] 对 349.06美元 ± 273.27美元；p = 0.72）。
这些结果表明，RTCS可能是一种有效策略，既能适当分配呼吸护理策略，又能节省提供呼吸护理的成本。
