A Primer on Respiratory Therapist-Driven Protocols

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Abstract
Misallocation of respiratory care services is widespread with both overordering and underordering reported. Specifically, available studies suggest that between 20% and 50% of respiratory care services ordered have low likelihood of providing clinical benefit. In a prior series at our institution, frequent overordering also was offset by underordering of respiratory care services (i.e., failing to provide appropriate services). To minimize misallocation of respiratory care services, recent attention has turned to the concept of therapist-driven protocols or a Respiratory Therapy Consult Service, in which respiratory therapists evaluate patients and use sign/symptom-based algorithms to prescribe respiratory care services. This article recommends the structure and function of a Respiratory Therapy Consult Service, citing our experience at the Cleveland Clinic Foundation. An ongoing observational prospective study has suggested that the rate of misallocation can be decreased substantially with a Respiratory Therapy Consult Service.

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