Therapist-driven protocols

Poor reliability for all conditions, differences in patient history and behavior, some not for intubated and tracheotomized patients, less usefiil in complex patients, omission of close attention to the patient, requirement of ongoing staff education, reduced ICU time shifts the length of stay and costs to another area, too rigid-cookbook style, not necessarily faster, nonphysician unable to modulate a therapist driven protocol, team conflicts, hard to demonstrate cost reductions... 

Duibin CG Jr. Therapist-driven protocols in adult intensive care unit patients. Respir Care Clin N Am 1996 2 105-116. 

Ely EW, Bennett PA, Bowton DL, et al. Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999 159 439-446. 

Abbreviations. TDP, therapist-driven protocols CRT, continuous rotational therapy ... 

Standardized weaning protocols are useful approaches for the difficult-to-wean patients (9-13). Therapist-driven protocols (TDPs) are daily care plans, which are drawn up by experienced staff and designed to be responsive to changes in the patient s condition, the latter being measured objectively by tracking physiological and clinical variables. 

Figure 1 Therapist-driven protocol. Algorithm for daily assessment during weaning attempt.

Vitacca M. Therapist driven protocols. Monaldi Arch Chest Dis 2003 59 342-324 (review). Bloomfield S A. Changes in musculoskeletal structure and function with prolonged bed rest. Med... 

Table 1 Tips for Implementation of Therapist-Driven Weaning Protocols Identify the patient-care issues...

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