Respiratory care protocols in the Cleveland Clinic Health System

Although respiratory care protocols have been proven efficacious in several academic medical centers, little attention has been given to their use and effect in community-based hospitals. To evaluate the use and effect of respiratory care protocols in community hospitals in the Cleveland Clinic Health System (CCHS) in Cleveland, OH, an observational study was conducted based on a survey of respiratory therapists from 9 of the 10 CCHS hospitals. Study results showed that respiratory care protocols had been implemented in most of the CCHS hospitals in a variety of formats and that use of a full respiratory therapy consult service was common. Over-ordering of respiratory care services was reported far more frequently than was under-ordering and was often the impetus to adopt respiratory care protocols. Larger hospitals were more likely to implement protocols, but protocol use was not associated with having a residency training program. Furthermore, in the three hospitals in which the issue was examined, use of respiratory care protocols did not appear to discourage pulmonary consultation. As was the case in academic medical centers, which have generated most studies to date, the use of respiratory care protocols was reported to be beneficial in community-based hospitals.