Standardizing Quality Metrics In Respiratory Therapy: A Comprehensive Literature Review Of Current Key Performance Indicators (Kpis) Using The Donabedian Framework

Abstract

Background:
Respiratory therapy (RT) departments are fundamental to patient care, particularly for individuals experiencing acute or chronic respiratory conditions. Measuring performance and quality in RT services is essential to improve patient outcomes, optimize resource utilization, and reduce hospital complications. Key Performance Indicators (KPIs) provide a standardized way to assess and monitor the efficiency and effectiveness of RT departments.

Objective:
This Comprehensive review aims to identify, categorize, and explain the current KPIs used in respiratory therapy, based on the Donabedian framework of structure, process, and outcome. It also highlights challenges in KPI reporting and the importance of standardized definitions to facilitate quality improvement.

Methods:
A comprehensive review of recent literature and healthcare reports was conducted to extract KPIs relevant to respiratory therapy. These KPIs were classified into three domains: structural (e.g., staffing ratios, equipment availability), process (e.g., ventilator bundle adherence, sedation protocol compliance), and outcome indicators (e.g., mechanical power, ventilator-associated pneumonia rates, mortality). Calculation methods, data sources, and clinical relevance were summarized.

Results:
Structural KPIs focus on workforce characteristics and equipment adequacy, with evidence highlighting staffing shortages and uneven resource distribution affecting care quality. Process KPIs primarily measure adherence to evidence-based practices such as ventilator care bundles and sedation protocols, which correlate with reductions in ventilator-associated complications and improved survival. Outcome KPIs include mechanical power applied during ventilation, incidence of ventilator-associated pneumonia, mortality rates, ventilator-free days, and oxygenation indices. Challenges in KPI application stem from variability in definitions and measurement approaches, limiting comparability across institutions.

Conclusion:
Standardized KPIs categorized by structure, process, and outcome are essential for monitoring respiratory therapy performance and guiding quality improvement efforts. Addressing challenges in KPI measurement and harmonizing definitions will enable better benchmarking and enhance patient care. Implementing these KPIs consistently can support RT departments in improving clinical outcomes and optimizing resource allocation.