A comparative analysis of arranging in-flight oxygen aboard commercial air carriers.

INTRODUCTION: As air travel has become more commonplace in today's society, so too has air travel by oxygen-using individuals. Because there is little oversight or standardization of in-flight oxygen by the Federal Aviation Administration, individual airlines' policies and practices may vary greatly. On the premise that such variation may cause confusion by prospective air travelers, we undertook the current study to describe individual air carriers' policies and practices and to provide guidance to future air travelers. METHODS: Data were collected by a series of telephone calls placed by the study investigators to all commercial air carriers listed in the 1997 Cleveland Metropolitan Yellow Pages. The callers were registered respiratory therapists who identified themselves as inexperienced oxygen-requiring travelers wishing to arrange in-flight oxygen for an upcoming trip. Standard questions were asked of each carrier that included the following: Did the carrier have a special "help desk" to assist with oxygen arrangements? What oxygen systems, liter flow options, and interface devices were available? What was the charge for oxygen? How was the charged determined? What documentation from the physician was required? How much notification was required by the airline before the actual flight? In addition to recording these responses, the total amount of time spent on the telephone by the caller was logged along with the number of telephone calls and number of people spoken to in arranging in-flight oxygen. To compare oxygen charges between airlines, we calculated charges based on a "standard trip," which was defined as a nonstop, round-trip lasting 6 h in which the traveler used a flow rate of 2 L/min. RESULTS: Of the 33 commercial air carriers listed in the directory, 11 were US-based carriers and 22 were international-based carriers. Seventy-six percent of the airlines offered in-flight oxygen. For the 25 carriers offering in-flight oxygen, mean phone time required to make the arrangements was 9.96+/-4.8 min (range, 3 to 20 min). No more than two telephone calls were required to make oxygen arrangements. Most carriers required 48- to 72-h advance notice, with a single carrier requiring 1-month advance notice. Most carriers required some notification of oxygen needs by the traveler's physician. There was a great variation in oxygen device and liter flow availability. Liter flow options ranged from only two flow rates (36% of carriers) to a range of 1 to 15 L/min (one carrier). All carriers offered nasal cannula, which was the only device available for 21 carriers (84%). Actual charges for in-flight oxygen also varied greatly. Six carriers supplied oxygen free and 18 carriers charged a fee (range, $64 to $1,500). One airline allowed the traveler to bring one "E" cylinder with no fee assessed. For 14 of the 18 carriers that charged, the charge for the standard trip ranged from $100 to $250. CONCLUSIONS: (1) As expected from the lack of standard regulations, the availability, costs, and ease of implementing in-flight oxygen vary greatly among commercial air carriers. (2) Because the expense of in-flight oxygen is usually borne by the traveler (rather than by insurers), prospective travelers should consider charges for oxygen use when choosing an airline. (3) In the context that the current study shows substantial variation in oxygen policies, costs, and services among commercial air carriers and that such policies may change over time, our findings encourage the prospective air traveler needing in-flight oxygen to "shop around."

Physician-ordered respiratory care vs physician-ordered use of a respiratory therapy consult service: early experience at The Cleveland Clinic Foundation.

BACKGROUND: Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation. METHODS: The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients). In the pilot study, Therapist Evaluators responded to requests for Consults on two study wards. All staff therapists participated in implementing Evaluator-determined treatment. STUDY DESIGN: We evaluated 38 patients (20 of whom were Consult patients) randomly selected from a total of 82 patients undergoing abdominal surgery during the study period. RESULTS: Consult patients were significantly older than non-Consult patients, more likely to be heavy smokers (67 vs 43%), and sicker as suggested by a higher Triage Score. Consult patients received more types and more total respiratory care services, demonstrated a trend toward longer stay, and had significantly higher respiratory therapy charges. CONCLUSION: Our experience shows that a consult program can be successfully implemented in a large, tertiary care institution with widespread physician and nursing support. Whether the RTCS fulfills its goal of ameliorating misallocation of respiratory care has yet to be proven and awaits the completion of other studies currently under way.