The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

HOSPITAL DISCHARGE OF TECHNOLOGY DEPENDENT PATIENTS: ROLE OF A DEDICATED RESPIRATORY CARE PRACTITONER

Donna K. Tearl CRT, Timothy J. Cox, RRT, James H. Hertzog, MD. Departments of Respiratory Care Services and Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE.

Background: Preparation of technology dependent children for hospital discharge presents many challenges. Adequate training and education of caregivers, discharge planning, and coordination with the Durable Medical Equipment (DME) and home-nursing companies must be completed. A process utilizing multiple Respiratory Care Practitioners (RCP) to achieve this may not be efficient. We evaluated our model where a dedicated RCP discharge coordinator provides education and coordinates discharge planning.

Method: In June 2000, we instituted a system utilizing a dedicated RCP discharge coordinator to manage the needs of technology dependent patients. This system provides a single contact for caregivers and outside agencies, a single respiratory care educator for the caregivers, and utilizes a clinical pathway involving the entire multidisciplinary team. Patient length of stay (LOS), number of training sessions, and customer satisfaction were evaluated before and after implementation. Statistical analysis was performed using t-test, Mann Whitney U test, and Chi Square. Results: Data was gathered on 76 technology dependent patients from 1999-2001. Table 1 shows LOS. LOS decreased 41% after implementation. This decrease did not reach statistical significance (p = 0.055). Table 2 shows the results of two surveys asking (1) DME personnel if they were satisfied with the quality of caregiver training and (2) multidisciplinary team members if they were satisfied with the respiratory care educatorÕs performance. Statistically significant improvements in satisfaction were demonstrated for both groups (p < 0.001 for DME, p < 0.002 for team). Average training sessions increased 19% from 2000 to 2001.

Table 1
  # PATIENTS LOS
Before 25 82 days
After 51 48 days
Table 2
  DME Team
Before 86% 82%
After 94% 98%

Conclusion: Our model of a designated RCP discharge coordinator/educator for technology dependent patients was associated with increased training sessions, increased satisfaction with the quality of caregiver training by DME personnel, and increased satisfaction with the discharge process by the members of the hospital multidisciplinary team. Although not statistically significant, there was a trend toward a decreased LOS with this system.

OF-02-061

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