Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.

[Sleep-apnea syndrome, mechanical ventilation and critical care in Archivos de Bronconeumología (December 2009-December 2010)]. / El síndrome de apnea del sueño, la ventilación mecánica y los cuidados críticos en Archivos de Bronconeumología (diciembre 2009-diciembre 2010).

The present study aims to review all the major articles on respiratory sleep disorders, mechanical ventilation, and respiratory critical care published in the last year in Archivos de bronconeumología. Between December 2009 and November 2010, 15 studies on these topics were published in Archivos de bronconeumología. Ten of these studies dealt with respiratory sleep disorders, consisting of six original articles, one special article, one review article, one letter to the editor and one supplement on chronic obstructive pulmonary disease and its association with sleep apneas. Five articles were published on non-invasive mechanical ventilation: one editorial, one special article, one article in a supplement and two original articles. As in previous years, there was a marked difference in the number of articles published on non-invasive mechanical ventilation and sleep-apnea syndrome, with a greater number of articles being published on the latter. Although some articles highlight the importance of the place where ventilation is commenced, no study specifically dealing with intermediate care units was published in Archivos de bronconeumología in 2010. This absence could be interpreted as a result of the low implantation of this type of unit in Spain, contrasting with the high activity undertaken in this field by pneumology services.

The cost-effectiveness of outreach respiratory care for COPD patients.

An acute respiratory assessment service was established in a hospital that serves an area with a large number of COPD patients. The service aims to prevent unnecessary hospital admissions and provides a detailed patient assessment, treatment at home where appropriate and support. An economic evaluation demonstrated that the service was also cost effective.

Principals of design and evaluation of an information system for a department of respiratory medicine.

OBJECTIVES: To evaluate a departmental computer system. DESIGN: a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems. SETTING: Within a department of respiratory medicine serving a hospital of 1323 beds. MAIN OUTCOME MEASURES: a. Time taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs. RESULTS: a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS = 7.63 min/test, MS = 12.25 min/test), loan of equipment (CS = 0.40 min/loan, MS = 2.07 min/loan), and checking for overdue equipment (CS = 0.49 s/record, MS = 9 s/record). The production of correspondence was slightly slower with the computer (CS = 9.30 min/letter, MS = 8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of in-patient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988-1990 were high (72,178 pounds). Only 1200 pounds to 1845 pounds per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (4049-4765 pounds). After 10 years the projected deficit is 10,000 pounds per annum in running costs. CONCLUSIONS: In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay.

Outcomes management and asthma education in a community hospital: ongoing monitoring of health status.

An outcomes management system was implemented to evaluate the effectiveness of an asthma education program and to test its feasibility as a quality improvement tool. The study demonstrated the value of continuous monitoring of health status and the advantages of a multidimensional approach to outcome assessment and program evaluation.

Evaluation of an antibiotic prescribing protocol for treatment of acute exacerbations of chronic obstructive airways disease in a hospital respiratory unit.

A prescribing protocol for infective exacerbations of chronic obstructive airways disease (COAD), specifying the use of oral amoxycillin 500 mg tid (or erythromycin 500 mg qid if allergic) as first line therapy, and oral ciprofloxacin 500 mg bd as second line treatment, was introduced in 1991. Every third sequential admission was screened for the year preceding (1990) and the year after (1991) the protocol was implemented. Only those patients with a discharge diagnosis of infective exacerbation of COAD, but without pneumonia, were included in the analysis. The two groups (1990 and 1991) were matched in terms of age, sex and pre-treatment given by their General Practitioner (GP), but differed with respect to severity score, with 1991 being more severe. The outcome measures showed that duration of hospital stay was comparable as was duration of treatment. Response to first line therapy was 68% and 67% for 1990 and 1991, respectively. Of those who had received antibiotics from their GP, 67% responded to first line therapy, while of those who had not received antibiotics from their GP 75% responded. Duration of therapy was shorter in first line responders (mean and 95% CI: 7.3 (6.3-8.3) days vs 12.7 (10.1-15.3) days). The mean cost per day antibiotic treatment was reduced by 54.6% (95% CI 52.3-56.9%) from 3.77 pounds to 1.71 pounds. In conclusion, the introduction of antibiotic prescribing guidelines for treatment of infective exacerbations of COAD showed no detrimental effect on outcome measures, but was associated with a significant reduction in the cost of antibiotic therapy.

RCPs (respiratory care practitioners) and health-care reform: demonstrating value, creating opportunity.

We should embrace respiratory care protocols. We have had a system in our hospital for more than two years; it has been very successful. We have approximately 60-70% of all of our therapy now ordered by a true protocol process. Some people have been dragged kicking and screaming through this process, including a number of respiratory care practitioners. It is more work. It is harder. Yes, it takes more time and more work to be a professional, but a professional is what you want to be. Anybody can go around and stick those nebulizers in people's mouths, but not everyone has the skill to determine which patients do not need that nebulizer or which may need a different drug or a different therapy. We must demonstrate through projects our ability to have an impact on the delivery of unnecessary and inappropriate care, and we must have physician support for what we are doing. These elements are essential to our survival. When we embrace appropriate and effective technology, we demonstrate value. If we show--through improved weaning technology--that we can decrease length of stay by decreasing the time that people are on ventilators, we demonstrate value. If we function as effective bronchoscopy assistants who help to treat people and get them out of the hospital or avoid hospitalization entirely, we demonstrate value. So, we must embrace technology. We need to function across the entire continuum of care to demonstrate value. We need to start managing health instead of managing illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiratory care.

In summary, the field of respiratory care has witnessed a continuum of accelerating change in its first half century of existence as a health care profession. These changes were effected by internal change agents as well as external forces in the health care arena. Based upon a health care system undergoing a near cataclysmic pace of change in a time of multifocal and critical inspection, it is anticipated that the field will undergo an even more dramatic change in its scope and direction in the next 50 years. With the guidance and assistance of administrators, medical staff, and partner departments, the respiratory care department should continue to function as an integral part of the hospital organization.

Computerized management of respiratory care.

Respiratory care as an organized discipline is only about 45 years old, and the management of this dynamic allied health profession has usually been characterized by a demand-for-service mentality. As pressure continues to control costs, those departments that maximize quality patient care cost-effectively with thoroughly documented outcomes are in a better position to compete for future resources. The practice of respiratory care is changing as is the practice of medical care in general. Accountability for resource consumption and the quality of the product delivered are essential elements in the delivery of respiratory modalities. We have developed and implemented a comprehensive patient-data-based approach to the management of respiratory care. The essential elements of this approach are (1) relative-value-unit procedure base; (2) individual, shift, and department productivity that is attached to the annual performance review process; (3) management reporting on a 24-hour basis, with biweekly review at the management level; (4) development and implementation of a comprehensive patient-data-documentation system that permits automatic patient billing and 100% data review for quality-assurance documentation; (5) the development of a medical alerting system that alerts the Medical Director and Respiratory Care staff to potentially harmful events that, if untreated, may result in increased morbidity or mortality; and (6) the development of concurrent and retrospective tools for patient-outcomes research. These functions are supported by an active Medical Informatics Department that is nationally recognized in medical computing and logic application.

Computers in respiratory medicine.

Information ranging from patient symptoms to bed state is essential for the efficient functioning of clinical services. Computers have a central role in organizing this information and this review illustrates the impact of their introduction on clinical hospital departments.

Building a quality culture through small and large successes.

Total quality management (TQM) is a unifying business strategy for achieving and sustaining growth. TQM proceeds, step by step, project by project, to transform the organization into one smoothly working, quality-focused team. For successful implementation of TQM, the small projects are every bit as important as the large ones. The simple, accessible successes validate the skills that employees are acquiring and encourage them to try more complex, long-term endeavors. This article discusses several TQM projects conducted at Baptist Medical Center in Columbia, SC: streamlining medical records processing (a large project that freed up millions of dollars in cash flow); improving the reliability of all hospital equipment; and ongoing small successes in the recovery room. Although the dollar value of the projects varied considerably, all were critical to creating a culture of total quality management at Baptist Medical Center.

What's involved in a program transfer between hospitals?

More hospitals are being forced to restructure in a bid to cope with financial constraints. One effective option is the transfer of clinical programs between facilities. The procedure is complicated and commands good leadership, negotiating skills, trust and a comprehensive understanding of the program being transferred. This article deals with the knowledge gained from the recent successful transfer of the Adult Cystic Fibrosis Program and its associated operating funds from one Toronto hospital to another.

A specialized home care team does make a difference.

Results of a study done in a large teaching and research facility in Alberta reveal that a specialized home care team can substantially lower the cost of caring for people who are ventilator dependent. With the assistance of a pulmonary physician, the Respiratory Home Care program has shown excellent results. Patients report that they "feel as safe at home as in the hospital", and the savings to the health care system are estimated to be about $2,000,000 per year.

Expanding technologies and responsibilities for respiratory care medical directors and practitioners.

An awareness of current economic factors is necessary for respiratory care medical directors and practitioners to understand their important new responsibilities. These include accurate documentation and cost analysis of every departmental activity so that clinical and fiscal considerations can be properly balanced. All procedures and purchases should be evaluated in light of medical necessity and cost. In this way, respiratory care can be provided in a manner that both maximizes patient care and reduces hospital costs.