Therapist-driven protocols in adult intensive care unit patients.

TDPs occasionally are used to standardize or control respiratory management of the critically ill. Weaning protocols are most common. Little objective evaluation of the effects of TDPs in the critically ill has been published. Most protocols have been developed to improve efficiency of respiratory care staff and reduce unnecessary treatments in non-ICU patients. The most important reason for using TDPs in the ICU is to improve consistency of care. Reduction of variation between individual therapist style improves physicians' trust in the respiratory care department. Improved consistency may allow novel ICU therapies to be evaluated objectively. In general, TDPs are not directly transportable from one area or institution to another. TDPs require local development, and all interested parties must be part of the development process for success. The process of creating TDPs provides a forum for physicians, nurses, and therapists to establish mutual respect and understanding. The analytic approach needed to create useful TDPs provides a critical evaluation of unit procedures and promotes changes in care delivery extending outside the TDP. The complexity of disease process and patient care in the ICU makes comprehensive TDPs difficult to establish; however, use of computers for decision support can overcome the limitations of paper flow charts. Even without comprehensive TDPs, the development process is important to improving and understanding care of the critically ill. The effects of TDPs on ICU patient outcome are unknown currently. Benefits are possible and improved collaboration, better respiratory care staff morale, consistency of approach to care, and critical approach to clinical decision making can be gained by attempting to develop TDPs for respiratory care delivery in the ICU.