The Effects of Therapist-Evaluation of Orders and Interaction with Physicians on the Appropriateness of Respiratory Care

Because our Respiratory Care Department resources were overburdened and many orders for medicated aerosol therapy (MAT) and lung hyperinflation therapy (LHT) seemed inappropriate, we developed ordering guidelines for MAT and LHT. We then studied the effects on numbers of inappropriate treatments when therapist-evaluators discussed questionable orders with physicians. METHODS: For 6 weeks, the physicians were divided into two groups, one interactive with therapists, the other serving as controls. The physicians then switched groups for a second 6-week period. Therapist-evaluators examined all orders for MAT and LHT and suggested therapy changes to interactive-group physicians who wrote questionable orders; they did not discuss inappropriate orders with control-group physicians. The percentages of inappropriate treatments ordered by both physician groups were recorded, and the costs of inappropriate therapy were calculated. After the 12-week study, the program continued, with evaluators interacting with all physicians when treatment was inappropriate. RESULTS: Of treatments ordered by control-group physicians, 48% were inappropriate. Of treatments ordered by physicians in the interactive groups, 35% were inappropriate. Inappropriate treatments cost $15,960 in labor and supplies and required 3.6 full-time technicians. The cost of evaluation was $1,193. By 6 months following the study, therapist-physician interaction had reduced inappropriate treatments to 11% of treatments given. CONCLUSIONS: The use of ordering guidelines and therapist-evaluators who interact with physicians can significantly reduce the number of inappropriate respiratory care treatments and reduce costs.