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Increases in the utilization of respiratory therapy and the need to avoid its misuse have placed increasing management responsibilities on medical and technical supervisors of respiratory care services. To improve our managerial capabilities we designed a computerized respiratory care record system. Respiratory therapists use specially designed forms to record initial respiratory assessments and subsequent progress notes. A computer program allows secretaries to enter information from the forms into a data base. Another program tabulates information from the data base. As an example of the usefulness of this system we present a study of the utilization of intermittent positive-pressure breathing (IPPB) therapy in patients undergoing intrathoracic or upper abdominal surgery. Although all such patients were routinely educated preoperatively in the use of IPPB, chest physiotherapy, and incentive spirometry, the study revealed that only 14% of the patients received IPPB postoperatively, whereas more than 90% received chest physiotherapy and incentive spirometry. As a result of our findings we are saving time and money by discontinuing routine IPPB education for this population.

Unlabelled: We prospectively investigated strategies for assuring that oxygen was provided to patients hospitalized in our institution, according to standard indications (Blue Cross/Blue Shield Medical Necessity Guidelines)., Method: After a baseline observation period (Phase I) during which no specific interventions were made, therapists were informed that appropriate oxygen utilization was an administrative goal and a department priority, and intensive instruction and case review were provided by the Technical and Medical Directors (Phase II). In Phase III, therapists were encouraged to continue to assure that guidelines were met, but instruction, discussion, and review ceased, and the Technical Director assumed responsibility for all oxygen therapy decisions. Finally, all concerted policing activity by the Technical Director ceased (Phase IV)., Results: The total number of patients and percentage of patients with no indications for therapy fell progressively through Phases II and III and returned almost to baseline after policing activities were discontinued in Phase IV., Conclusions: We believe that it is unlikely that any department can sustain the educational and supervisory input necessary to assure optimal conformance to published standards for oxygen therapy when all members are involved. Therefore, assigning one qualified person to manage oxygen therapy may be more successful than other approaches. Requiring all therapists to monitor conformance to standards for low-flow oxygen therapy is time consuming and less effective and limits the time that can be spent caring for patients with problems that respond favorably to other forms of respiratory therapy.

Two major issues that respiratory care managers must deal with are overutilization of services and cost containment. Using the therapy evaluation program detailed here, respiratory personnel assist the physicians in therapy assessment, communicate suggestions to them, and document the patient care plan on a concurrent patient care audit form.