Accountable Care Clinical Pathway Standardizing Airway Clearance and Lung Expansion in Efforts of Reducing Nonproductive Respiratory Care

Background:

There is considerable overlap in the array of techniques offered by respiratory care practitioners when managing clinical disorders resulting from poor airway clearance and/or poor lung expansion. To date, there remains insufficient evidence to suggest that one technique is superior to another, however ordering practices are for the most expensive techniques at a frequency and duration that creates unprecedented cost in respiratory care services. In one fiscal year, more than $800k was spent delivering airway clearance and lung expansion techniques. Respiratory Care Service believes that individualizing the administration of an airway clearance technique and/or lung expansion technique will increase communication between Respiratory Care Service and Hospital Medicine/Surgical Services; thereby reducing cost associated with those airway clearance and/or lung expansion techniques that are expensive. Individualized respiratory care will promote timely initiation and follow-up assessments in patients ordered for an airway clearance and/or lung expansion technique.

Methods:

Using a collaborative evidence-based algorithm that empowers Respiratory Care Practitioners (RCPs) in providing individualized and cost-effective care, the goals of this project is to implement a combined airway clearance and lung expansion (ACT/LET) pathway driven by respiratory care practitioners at a large academic medical center. This project is also intended to increase respiratory care service's staff engagement and physician collaboration.

Results:

The ACT/LET Pathway has been successfully adopted by the Medicine/Surgical (Med/Surg) Services prescribing respiratory care techniques to hospitalized patients with a target of reducing the total number of techniques by 10% in efforts of reducing unnecessary techniques. The ACT/LET Pathway exceeded expectations by reducing the total number of airway clearance and/or lung expansion techniques between April 2016 and June 2016 by 17. 3% as compared to the same time period in the year prior. The ACT/LET Pathway also improved RCP and Med/Surg collaboration as well as increased Respiratory Care Service's staff engagement.

Conclusions:

This project underscores the importance of evidence-based practice and clinical pathways in reducing medical cost during patient care. It also suggests that transdisciplinary collaboration promotes staff engagement.

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