Physician-ordered aerosol therapy versus respiratory therapist-driven aerosol protocol: the effect on resource utilization

The utilization of respiratory therapist (RT) driven protocols for single interventions, such as oxygen titration and bronchopulmonary hygiene, and protocols consisting of multiple interventions have been associated with improvements in resource utilization. Based on this, we started a quality improvement project to transition the delivery of respiratory care services from physician-ordered treatments to RT-driven protocols. During the first phase of our quality improvement project, we compared the frequency of bronchodilator administration and its associated costs, between a physician-ordered bronchodilator strategy and a RT-driven bronchodilator protocol strategy. This was a retrospective analysis of prospectively collected data obtained during the initial phase of a quality improvement project. Over a period of 2 weeks, RTs administered physician-ordered bronchodilator treatments. During this time they assessed the subjects' clinical status and what they would have recommended in regard to bronchodilator treatment frequency following an RT-driven protocol. Forty-eight subjects were ordered bronchodilator treatments, which resulted in 88 assessments. The utilization of a protocol would have resulted in 42 (47.7%) bronchodilator orders administered "every 6 hours, as needed," and 27 (30.6%) orders administered "every 8 hours," compared with 2 (2.2%) and 2 (2.2%), respectively, in the physician-ordered group (P < .001). Conversely, physician-ordered treatments were prescribed "every 4 hours" in 56 (63.6%) cases, compared with 10 (11.3%) in the RT-driven protocol group (P < .001). Total bronchodilator therapy cost in the physician-ordered group was $1,672.85, whereas it would have been $904.53 in the RT-driven one. Per patient costs were $19.0 ± 6.9 in the physician-ordered group, and would have been $10.3 ± 9.4 in the RT-driven bronchodilator protocol group (P < .001). The application of an RT-driven bronchodilator protocol can hypothetically reduce the frequency of bronchodilator treatments, compared with a physician-ordered strategy, resulting in a theoretical reduction of costs in patients who require bronchodilator therapy.