Appropriateness of respiratory care: development of evidence-based guidelines in an acute care hospital

TitleAppropriateness of respiratory care: development of evidence-based guidelines in an acute care hospital
Publication TypeConference Paper
Year of Publication2009
AuthorsRosière, J, Vader, J-P, Cavin, MSokol, Grant, K, Larcinese, A, Voellinger, R, Burnand, B, Revelly, J-P, Fitting, J-W
Conference NameJoint annual meeting of the Swiss Respiratory Society, Swiss Society of Occupational Medicine, Swiss Paediatric Repiratory Society [and] Swiss Society for Thoracic Surgery, Davos (Switzerland), April 16/17, 2009
ISBN Number1424-7860
Accession Numberserval:BIB_34781B9C5844

Background: Respiratory care is universally recognised as useful, but its indications and practice vary markedly. In order to improve appropriateness of respiratory care in our hospital, we developed evidence-based local guidelines in a collaborative effort involving physiotherapists, physicians, and health services researchers.
Methods: Recommendations were developed using the standardised RAND appropriateness method. A literature search was performed for the period between 1995 and 2008 based on terms associated with guidelines and with respiratory care. Publications were assessed according to the Oxford classification of quality of evidence. A working group prepared proposals for recommendations which were then independently rated by a multidisciplinary expert panel. All recommendations were then discussed in common and indications for procedures were rated confidentially a second time by the experts. Each indication for respiratory care was classified as appropriate, uncertain, or inappropriate, based on the panel median rating and the degree of intra-panel agreement.
Results: Recommendations were formulated for the following procedures: non-invasive ventilation, continuous positive airway pressure, intermittent positive pressure breathing, intrapulmonary percussive ventilation, mechanical insufflation-exsufflation, incentive spirometry, positive expiratory pressure, nasotracheal suctioning, noninstrumental airway clearance techniques. Each recommendation referred to a particular medical condition, and was assigned to a hierarchical category based on the quality of evidence from literature supporting the recommendation and on the consensus of experts.
Conclusion: Despite a marked heterogeneity of scientific evidence, the method used allowed us to develop commonly agreed local guidelines for respiratory care. In addition, this work fostered a closer relationship between physiotherapists and physicians in our institution.




Citation Key / SERVAL ID3987


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