2002 OPEN FORUM Abstracts
RCPs EXPANDED ROLE IN THE EMERGENCY DEPARTMENT
Susan K. Waggoner RRT and Jeni R. Kirsch RRT. Respiratory Care Services (RCS). Nebraska Health Systems, Omaha, Nebraska.
The beneficial effects of having a Respiratory Care Practitioner (RCP) play a role in the Emergency Department (ED) has been documented in the literature. However, a lack of information in the literature exists in trialing RCPs staffing in the ED 24 hours/7 days a week while expanding their role and assessing subsequent impact. We conducted a trial from Nov.14, 2001 through Dec. 21, 2001. During the trial an RCP was staffed in the ED 7 days a week from 7a.m. until 7p.m and collected the following information: patient name, medical record number, triage time, treatment start time, Shortness of Breath (SOB) Pathway utilized (Y/N), education provided, patient admitted or discharged, time admitted or discharged and procedures performed. The triage time was compared to the treatment start time to assess response time. During the time a RCP was staffed in the ED, the mean response time to treatment given was 12.5minutes (mean + 12 minutes SD) with a range of 0-45 minutes. The mean response time during non-trial times in the ED (7 p.m. until 7 a.m.) was 27.6 minutes (16 minutes SD) with a range of 5-70 minutes. In these latter cases the RCP was notified when the patient was assessed and determined to need a treatment. Patients assessed by RCS during the trial and presenting with shortness of breath (43 patients) were placed on the SOB Pathway for treatment. Additionally, the majority of these same patients (35 patients) received education regarding their shortness of breath, disease management and medication regime. Eleven additional patients that were not placed on the SOB Pathway but determined to have a history of pulmonary disease received disease management education. Of these patients receiving education, the majority stated they had not received previous education in relation to disease management Of specific interest, three patients seen during non-trial hours were in the ED at least twice during the same 24-hour period. When these return visits occurred during the RCP trial hours, education was provided and the patients did not return to the ED. Included in the education component was a follow-up call to those non-admitted patients 24-48 hours after discharge to the ED. The purpose of the call was to answer any questions the patient might have and to reinforce any education. Of the patients seen in the ED during non-trial hours, none were placed on the SOB Pathway. Of these 29 patients qualifying, only two received education regarding their shortness of breath, disease management and medication regime. During the trial 77% of the patients with pulmonary disease and treated by RCS were discharged from the ED; the remaining 23% were admitted. During non-trail hours only 52% of the patients with pulmonary disease were discharged from the ED with the remaining 48% admitted. It also appears that from the data those patients treated during the trial had fewer aerosol treatments given prior to admission (average 2.2 treatments), than those admitted during non-trial hours (average 4.1 treatments). Additionally, the data noted the average time spent in the ED before discharge or admission was 183 minutes (107 minutes SD) for those patients seen during non-trial hours versus 156 minutes (+72 minutes SD) for those patients seen during trial hours. In summary, RCPs role in the ED would provide enhanced patient care to those patients treated in the ED. The patients in the ED during trial hours were either admitted or discharged sooner than those non-trial patients. This could have potential financial impact on the ED as volumes could increase with patients moving out of the ED sooner. Patients during trial hours were responded to sooner than patients during non-trial hours. This could have impact on patients admit or discharge times. Those non-trial patients also received more aerosol treatments, which could mean these patients received non-indicated treatments. In conclusion, the results of this trial indicate that RCPs have a significant role in the ED in improving patient care and potential patient outcomes.