Thursday, May 29, 2008

Protocols Do Work.

Today I had to come into work early due to the requirement of the monthly Staff Meeting. Ohh what fun, but I did actually gain some information this time that I thought was pretty interesting.

If you have read one of my earliest posts I talked about a Therapist Driven protocol that we had implemented at my little hospital about 7 months ago. This protocol had to do with us the RT's assessing patient and then being able to adjust nebulizer, MDI and Oxygen therapy's as we deemed needed. Well we are now done with the testing phase of the implementation of our therapist driven protocol and a letter from our director is out to the doctors with surveys to see if we continue with this type of therapy.

There are some statistics that we pretty interesting that were compared from this 6 months of the protocols being in use and the 6 months prior to the protocols being in use. These stats were pretty interesting and pointed in favor of using these protocols and making them law. The only areas of care that were talked about were patients with Pneumonia and COPD issues.

Hospital staylLengths for Pneumonia and COPD decreased by 1 day in both areas. So we were able to adjust treatments for the patients and decrease their length of time in the hospital.

Now here is what I though was pretty amazing in the financial aspect.

In patients with a Pneumonia the cost of Respiratory Therapy given to the patient was DECREASED by 23% with the protocol in use. We saved the hospital 23% per patient on average if they had pneumonia.


Patients in with a COPD issue the cost of Respiratory Therapy given to the patient was DECREASED a whopping 36% with the protocol in use. Here we saved the hospital 36% per patient on average if they were in for COPD.

These facts speak strongly for the use of Therapist driven protocols and that we might actually know what we are doing.

During this meeting I did get into a disagreement with the director and supervisor about how we should for the first 24 hours do the treatment exactly how the doctor ordered it due out of respect to the doctor so they don't think we are just saying they don't know what they are doing.

Whats the point of doing the protocol assessments in the first 24 hours if we are not going to change anything? The doctors signed off on the protocols, so we have a right to use them as needed, otherwise you need to change what the protocol says.

I think I stunned the director when I said "So basically you two want us to suck up to the doctor's so they don't feel bad?" They said no it's a teamwork thing.

I don't know I feel as though if we don't use the protocol as written the doctor's might get the impression that we are skeptical on our abilities as therapist to assess our patients and choose the right treatments.

Fortunately I have a couple of other therapist who agreed with me and backed me up in my thoughts. Good to know I wasn't alone in my thoughts. So this was to be a unwritten rule that I'm not so sure people will follow. I for one will keep doing it as I have been and that's by the book on how the protocol was written up. Can't get into trouble for that.

Statistics show that we must be doing something right, and there are no complaint's about how we have done our assessments so far. Hopefully the doctors do really see it that way and the surveys come back in good shape, then we can make this law and continue on.

Drive on RT's

1 comment:

Freadom said...

One question for you. In order to meat criteria with some patients, doctors have to order treatments for some patients. For examle, for pneumonia patients to meat criteria for payment by medicaid, they have to at least have QID txs. Is this a concern in your state, and is it something you have to consider in your protocol? Just curious.