1995 OPEN FORUM Abstracts
EFFECT OF MULTI-SKILLED RESPIRATORY CARE PRACTITIONERS ON A DEPARTMENT OF EMERGENCY MEDICINE.
Rebecca L. Meredith. RRT, Nina M. Fielden, MSN, RN. The Cleveland Clinic Foundation, Cleveland, Ohio.
INTRODUCTION: In 1994, the expanded Emergency Department (ED) at our institution was faced with the challenge of providing respiratory therapy services. The new ED is remotely located away from the main hospital and respiratory therapy response times range from eight - 12 min. The bed capacity is five times larger with a projected doubling of patient census. One respiratory therapy position was approved in the budget as an educator/ coordinator for the nursing staff. Respiratory Care Practitioners' (RCPs) have specialized skills in regard to airway management, mechanical ventilation, and other modalities available to optimize care. Multi-skilling and expanding the role of the RCP to include other patient care related duties such as EKG, phlebotomy/IV, central service and orthopedics were explored.
Methods: Five RCPs that were graduates from an AMA approved program for respiratory care were hired into previously approved Patient Care Technician (PCT) positions. These RCPs underwent a four-week PCT orientation program that included ED specific skills. The RCPs have assumed the technical roles of EKG, Phlebotomy/IV, Central Service, and Orthopedics along with their respiratory therapy skills. We further evaluated the adequacy of the multi-skilling based on the cost of personnel and orientation, RCP job satisfaction, and physician and patient satisfaction.
Results: Immediate availability of the RCP in the ED, has moved respiratory services closer to the patient, eliminating any treatment delay. Approximately 240 patients experiencing bronchospasm are seen in our ED per month. Of these patients, 130 require the delivery of three or more beta-agonists 20 min. apart, oxygen, IV(s) and ABG(s) with an average treatment duration of 60 - 90 min. The provider team of RN, RCP, and physician limits the number of health care personnel that the patient needs to see, decreasing patient stress. The RCPs manage most of the patients' care needs, allowing the RN to concentrate on other assignments. No additional orientation costs resulted due to the multi-skilled training. Based on volumes to date, we have estimated that, as an alternative, 5.5 additional RN positions would be needed to provide for the volume of respiratory procedures. The program has proven to be less expensive from a salary perspective, with an estimated annual savings of $21,000.00 based on the median salaries of RCPs and RNs. A RCP job satisfaction survey was conducted after 10 months. Results show that RCPs believe that being multi-skilled has increased their value to the institution (5/5), they fit well into the patient care team and are proud to be members (5/5). A survey of ED attending physicians revealed that eight of 10 use the RCP consistently and believe they are an essential part of the patient care team. They also believe the RCP has improved patient care efficiencies (10/10) and improved the quality of respiratory care (9/10). A continuous quality improvement program (CQI) has been established with preliminary results showing a high standard of respiratory care maintained by the RCP. A telephone call-back with RCPs contacting pulmonary patients discharged from the ED has initially shown patient satisfaction to be very good.
Conclusions: Multi-skilling RCPs has improved our ED operation by: 1. moving the services closer to the patient, eliminating treatment delay, 2. freeing the RN to concentrate on other assignments, 3. decreasing patient stress by creating provider teams, 4. saving salary costs related to efficient use of resources, 5. maintaining a high degree of RCP job satisfaction, 6. satisfying ED physicians, and 7. maintaining quality care.