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Friday, October 2, 2009

The two types of protocols

I have determined that there are two different kinds of hospital protocols.

1. Professional Protocols: Protocols that allow the professional (RN or RT) the opportunity to assess and treat as appropriate based on the guidelines of the protocol (i.e. an RT assesses patient and determines indication and appropriate drug, dose and frequency.)

2. Order Sheet Protocols: Protocols that are basically a list of procedures that are automatically ordered for a particular diagnosis. (i.e. some patients don't meet criteria unless a breathing treatment is ordered. Such is the case with pneumonia and RSV)

Professional protocols are more like the RT Driven protocols whereby the RT is allowed to use his experience and education to make the best decision for the patient, and are the protocols I refer to frequently on this blog.

These protocols work to the benefit of the RT in that they allow these professionals to fully utilize their skills, the hospital in that it eliminates wasteful spending, and the patient in that appropriate therapies are given as indicated.

Order Sheet Protocols are made with the sole intention of making money for the hospital. Some person sitting in an office in Washington D.C. decided it will only reimburse for this particular disease if the patient was sick enough to need certain procedures, such as a breathing treatment.

In order to be reimbursed for said diagnosis (pneumonia, RSV), an order sheet the hospital calls a protocol is made up so that certain procedures are automatically ordered.

This type of protocol amounts to inappropriate usage of a professional's time, inappropriate use of hospital recourse's, and inappropriate procedures being ordered on patients. It is for this reason we end up with bronchodilator breathing treatments on all RSV and pneumonia patients.

Thus, under Order Sheet Protocols the hospital does not make money on each individual procedure as Medicaid, Medicare and Major Insurance Companies pay one flat fee regardless of how many procedures are completed.

Also, Order Sheet Protocols often result in RT burnout and frustration, apathy. Professional Protocols work to the benefit of all parties involved.

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