Therapist-driven protocols and newer models for patient care delivery.

There continues to be increased scrutiny regarding the quality and cost effectiveness of health care delivery in this country. As stated previously, new models of patient care delivery are designed to streamline and simplify hospital procedures in order to enhance this quality and cost efficiency. There is evidence that many of the elements of patient-focused care are adding value to the quality and efficiency of care. Evidence also indicates that therapist-driven protocols offer a promising solution to the misallocation of respiratory care, which is now widespread. The greatest cost savings to hospitals, it has been shown, comes from the elimination of unnecessary care, which therapist-driven protocols are designed to reduce. In the bigger picture of patient care delivery, however, more extensive and critical evaluation is needed before hospitals commit large sums of money to redesign their infrastructures. In other words, it is not yet proved conclusively that new models of patient care delivery are enhancing quality while cutting costs. To date, there is little documentation by hospitals of improved service or financial outcomes associated with new models of patient care delivery. It is likely that decentralizing ancillary services, streamlining procedures, and cross-training employees can help hospitals improve patient satisfaction and staff efficiency. In fact, there is evidence that the cost-savings potential for hospitals that implement employee redeployment and cross-training can be significant. Although patient-focused care is worthwhile primarily as an effort to simplify care delivery, the biggest cost savings comes from eliminating unnecessary care entirely. Although the evidence does not yet support hospitals' taking a major plunge into patient-focused care, it has been shown that many elements of patient-focused care are worth implementing and can be done inexpensively. Inexpensive activities that are likely to produce meaningful cost and quality gains include cross-training employees in bedside ancillaries, redeploying medical records, redeploying admitting, redeploying support services, and adding automated drug and supply dispensing to nursing units. Hospitals can minimize their financial risks and still achieve many of the benefits of patient-focused care by taking a middle-of-the-road approach to restructuring and redesign.