Ford R M, Phillips-Clar J E, Burns D M
University of California, San Diego Medical Center, USA.
Respir Care Clin N Am. 1996 Mar;2(1):51-76.
In January of 1993, as part of a hospital-wide cost-reduction strategy, the University of California San Diego (UCSD) Medical Center Respiratory Care Department implemented a patient-driven protocol program designed to utilize the assessment skills and judgments of respiratory care staff, within physician-approved guidelines. This program produced a 60% reduction in the use of hand-held nebulizer therapy and chest physical therapy in the institution, with a substantial decrease in operational expenses. This article describes key elements of the implementation of protocol-driven programs, provides examples from the UCSD experience, and offers insights gained from others who have been successful agents of change. It describes patient-driven protocols, how they can be implemented, the barriers to and promoters of such protocols, and what the results can be for a respiratory care department.
1993年1月，作为全医院成本削减策略的一部分，加利福尼亚大学圣地亚哥分校（UCSD）医疗中心呼吸护理部实施了一项患者驱动的方案项目，旨在依据医生批准的指导方针，运用呼吸护理人员的评估技能和判断。该项目使该机构中手持雾化器治疗和胸部物理治疗的使用量减少了60%，运营费用大幅降低。本文描述了方案驱动项目实施的关键要素，提供了UCSD经验中的实例，并分享了其他成功变革推动者所获得的见解。它介绍了患者驱动的方案、如何实施这些方案、此类方案的障碍和推动者，以及呼吸护理部门可能取得的成果。
