2002 OPEN FORUM Abstracts
USE OF A RESPIRATORY ASSESSMENT SCORING SYSTEM IN AN ACUTE REHABILITATION HOSPITAL
Edward C. Burns, RRT, CPHQ; Armand D. Riendeau, RN, RRT, Eileen Haley, RRT, Dean Hess, Ph.D., RRT, Robert M. Kacmarek, Ph.D., RRT, Massachusetts General Hospital, Boston, MA and Spaulding Rehabilitation Hospital, Boston, MA.
Introduction: At this rehabilitation facility, patients on respiratory care services are classified into two major categories, complex-medical and non-complex medical, based upon a respiratory care needs algorithm. All patients classified as complex-medical receive their therapy from a respiratory therapist until reclassified as non-complex medical, at which time they receive therapy from a registered nurse. A standardized approach to assessing and tracking progress was required. The Respiratory Assessment Scoring System (RASS) was developed to provide the respiratory therapist with a standardized approach to measuring patient?s acuity and their rehabilitative progress during their stay on respiratory therapy services.
Method: A scoring grid was designed to assess ten categories consisting of five clinical and five rehabilitative focused aspects of care. The clinically focused categories consist of breathing pattern, breath sounds, cough effort/ability, sputum, and oxygen requirements. The rehabilitative categories consist of level of patient activity, mental status and learning capability, the knowledge of therapy and procedures, compliance and cooperation, ability to return demonstration. To verify the inter-rater reliability, we randomly selected 60 patients. The senior respiratory therapist assessed each patient within 15 minutes following a staff therapist?s evaluation. The senior respiratory therapist was blinded to the original RASS score. The validity of the RASS scores was established by correlating the patient?s initial RASS score with LOS on respiratory therapy, LOS on respiratory care services, LOS in hospital, and total respiratory care charges. The RASS system was incorporated into the current respiratory care computerized departmental billing system and workload distribution program. Each category is assigned a weight from zero and increasing in severity to a score of four. The patients are divided into four categories based on their overall RASS score. Category 1 RASS scores fall into the 0-8 range, category 2 in the 9-17 range, category 3 in the 18-36 range and category 4 in the 27-40 range.
Results: RASS was tested for inter-rater reliability with a correlation coefficient of 0.91, a mean difference of ?0.1 and a standard deviation of 2.2. RASS was also tested for validity and demonstrated a moderate degree of correlation between the initial admission date RASS score and the LOS on Treatments, LOS on Respiratory Care Services and LOS in the hospital, with an average coefficient correlation of 0.60.
Conclusion: Daily utilization of the RASS assists with preparing a more effective distribution and prioritization of work assignments based on acuity and assists with the patient care planning process and shift reporting. It also provides management with a tool to quickly gauge the overall workload, as well as, patient acuity. In addition, it enhances the reporting of productivity numbers by allowing an adjustment based on acuity.