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Respir Care Clin N Am. 1996 Mar;2(1):51-76.

Implementing therapist-driven protocols.

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  • 1University of California, San Diego Medical Center, USA.


In January of 1993, as part of a hospital-wide cost-reduction strategy, the University of California San Diego (UCSD) Medical Center Respiratory Care Department implemented a patient-driven protocol program designed to utilize the assessment skills and judgments of respiratory care staff, within physician-approved guidelines. This program produced a 60% reduction in the use of hand-held nebulizer therapy and chest physical therapy in the institution, with a substantial decrease in operational expenses. This article describes key elements of the implementation of protocol-driven programs, provides examples from the UCSD experience, and offers insights gained from others who have been successful agents of change. It describes patient-driven protocols, how they can be implemented, the barriers to and promoters of such protocols, and what the results can be for a respiratory care department.

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