Respiratory care clinics of North America
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Most therapist-driven respiratory care protocols deal with adult care. The greatest difficulty we have encountered when implementing pediatric protocols involves patient assessment. We have found that with any protocol the key factor is to monitor closely the result of the treatment and to analyze that outcome and compare it with the purpose of the therapy. When careful clinical assessments are accomplished, pediatric protocols can be established.
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In January of 1993, as part of a hospital-wide cost-reduction strategy, the University of California San Diego (UCSD) Medical Center Respiratory Care Department implemented a patient-driven protocol program designed to utilize the assessment skills and judgments of respiratory care staff, within physician-approved guidelines. This program produced a 60% reduction in the use of hand-held nebulizer therapy and chest physical therapy in the institution, with a substantial decrease in operational expenses. This article describes key elements of the implementation of protocol-driven programs, provides examples from the UCSD experience, and offers insights gained from others who have been successful agents of change. It describes patient-driven protocols, how they can be implemented, the barriers to and promoters of such protocols, and what the results can be for a respiratory care department.