Resp Care
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In the 1970s the demand in our hospital for bronchial hygiene therapy (aerosols, IPPB, incentive spirometry, chest physical therapy) had increased to such a level that 20-30% of the ordered therapy was not being administered. Because the respiratory therapists and medical directors were convinced that much of the ordered therapy was unnecessary, the Respiratory Therapy Department began a program in 1978 in which specially trained respiratory therapists were authorized to evaluate all non-intensive-care patients for whom bronchial hygiene therapy had been ordered. The program protocol consists of a medical record review, a physical assessment of the patient, the development of a patient-care plan, and a re-evaluation every 2-3 days of the patient's continued need for therapy. ⋯ After being adjusted to the 1981 Consumer Price Index (CPI), total charges for bronchial hygiene therapy were markedly decreased even though hospital charges increased 77.4% above the CPI inflation rate. Since the program was begun, the respiratory therapy staff has been able to administer all ordered respiratory care services to patients in a critical care setting and not less than 90% of ordered bronchial hygiene therapy to patients outside the intensive care unit. House staff, attending physicians, and patients and their families appear to be satisfied with the therapist-evaluators, and the morale of respiratory therapists seems to have improved as a result of their being able to take a more role in the treatment of their patients and to apply their skills to the patients most in need of them.
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The difficulties in delivering patient-care services in a pulmonary rehabilitation program (PRP), especially in a program with a multidisciplinary approach, can usually be overcome by first conceptualizing and then organizing the PRP within a human-service-agency framework. All human-service agencies have six service components in common. The following are the components and their applicability to the Harper Hospital (Detroit, Michigan) PRP: (1) Outreach and Referral--local physicians are informed of the program and asked to send referrals; (2) Intake--initial information about the patient is gathered and his initial eligibility for the program is determined; (3) Assessment--more information about the patient is obtained, all data are organized for easy use and accessibility, and a final determination of eligibility is made; (4) Service Planning--needed service consultations are determined and obtained; (5) Service Delivery--during which a respiratory therapist serves as coordinator of the linkage of the various service subsystems and facilitates communication among them; (6) Follow-Up and Maintenance--at 1-month, 3-month, 6-month, and 1-year intervals and after each rehospitalization. Through evaluation of the program process and the program outcomes, PRP administrators can modify PRP structure and staffing to enhance the effectiveness of service delivery.