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Friday, October 9, 2015

Why protocols will not eliminate useless Ventolin orders

So one of my respiratory therapist friends, of whom I will not name here even though he said I could, sent me an email a while back explaining why it is that respiratory therapist driven protocols will never result in a decrease in treatment loads.
  1. There will always be the belief that if the patient is short of breath we must do something
  2. People sitting in leather chairs in Washington decided that in order to meet criteria for admission a patient must have needed at least 3 treatments in ER.  It eludes them that hospitals would have physicians order them just so the hospital can be reimbursed
  3. People sitting in leather chairs in Washington decided that in order for a patient's stay to be reimbursed for certain respiratory conditions (pneumonia, CHF, COPD) the patient must have breathing treatments ordered.  This is under the fake belief that if treatments aren't needed why keep the patient.  It eludes them that there may be other reasons for keeping the patient, nor that ventolin does nothing for non-bronchospastic lung ailments. 
  4. They are convinced ventolin cures pneumonia
  5. They are convinced ventolin cures heart failure
  6. They are convinced ventolin enhances secretion clearance
Generally, physicians and administrators and politicians tend to ask this question when making a decision regarding respiratory therapy: "Does it feel good."  For instance, should we order treatments for pneumonia? Well, does it make me feel good.  Yes!  I feel like I'm doing something important and helping people out.  Yes! It makes the patient feel better, or at least like we are doing something useful

Generally, respiratory therapists and nurses ask the following question: "Does it do good? For instance, should we order treatments for pneumonia?  Well, does it do any good?  No! So then we recommend it not be ordered.  

We are usually trumped by too many people ask the wrong question. If ever there came a time when "Does it feel good?" is replaced by "Does it do good?", then and only then with true bronchodilator reform occur. 

Need I go on.  


Cheri Purk said...

The better questions might be, "Do breathing treatments decrease length of stay?" and "Do breathing treatments help prevent re-admissions given the correct diagnosis. I believe in the future once CMS actually starts to use evidence based medicine as a guide for reimbursement that we will start to see a decrease in useless treatments ordered for diseases they have no actual effect on. I know this idea scares a lot of therapists, but in the long run it would save a lot of wasted time and money for the hospitals.

john bottrell said...

The problem is, whether or not to give albuterol breathing treatments should be determined on a case by case basis, not based on diagnosis. For instance, three failed breathing treatments for COPD should not justify admission and more breathing treatments: it should signal that bronchospasm is not the problem and some other treatment ought to be tried.