1998 OPEN FORUM Abstracts
How Do You Justify Your Therapists in the Emergency Room?
Mr. David B. Morgan, RRT, RCP
The number of uninsured Americans increased again last year and the effect was felt most in the emergency department. Increasing numbers of people without a primary care provider are being triaged with the complaint of subjective dyspnea and requesting care. The use of the national asthma education prevention program guidelines for emergency room evaluation have been invaluable.
Patients are evaluated by pulse oximetry, peak flows, and auscultation by a respiratory therapist with the house staff on rotation in the ED. Using the NAEPP guidelines will indicate which care path a patient will receive. Those whose peak flow improves to 80% of predicted value, after bronchodialator therapy, receive discharge planning which includes peak flow and metered dose inhaler instruction and smoking cessation counseling if indicated. Patients are instructed to record their peak flow daily and to bring this information with them to their medicine clinic follow up, which is scheduled at the discharge desk if they lack a primary care provider.
Patient whose peak flow does not improve to 50% of predicted are evaluated for a continuous medication neblizer. Unless contra indicated these patients will receive a course of anti inflammatory therapy either intravenous, or oral. After a further hour of therapy if a patient still has a low peak flow and dyspnea at rest they are admitted.
Using NAEPP guidelines with a therapist in the ED has produced a ripple effect in workload for more than just the respiratory department. Housestaff are more prepared to assess patients for obstruction. Patients received outcome based focused instructions on the measurement of peak flow and MDI use. Nurses in the ED who used to do therapy have additional time for other aspects of care.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.