The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Innovatively Managing Patients: Assessing Care Treatments (IMPACT).



Edgar Delgado, RRT, Ray Tuttle, RRT, Mark Cohen, RRT, Jim Roth, RRT, Dave Pruszynski, RRT, Al Augustine, RRT, Cindy Valenta, RN, Wendy Grbach, RN. Departments of Respiratory Care and Nursing. University of Pittsburgh Medical Center (Presbyterian Campus), Pittsburgh, PA.


INTRODUCTION:
The Respiratory Care Department with 132 staff therapist, utilizes Medical Executive Committee (MEC) approved ‘pathways of care’. These Pathways are driven by patient’s physiology and acuity. Physician order was required for initiation of the pathways. Generally, care was delayed until patient need was identified, orders were written and Respiratory Care was notified. An “Evaluator” role was proposed in order to enhance early identification of patient need and timely initiation of Respiratory Care intervention(s).

METHOD:An “Evaluator” role with specific guidelines for daily assessment of all patients in three step-down units was established. The Evaluator developed and initiated care plans based on patients’ acuity and physiologic need as per MEC approved pathway criteria. The ‘house’ therapist completed the routine treatment rounds. The role of evaluator also included direct contact with physicians as needed for directions, and served as a resource to nursing staff for respiratory care guidance and support with educational inservices. Standardized guidelines were developed to assure consistency in the evaluation process. To assess impact of the pilot “Evaluator” project, we monitored: Respiratory related codes, ICU re-admits secondary to Atelectasis, evaluator initiated interventions based on pathway criteria, length of Stay for all patients and nursing staff survey for a period of 8 months.

RESULTS: QI data (prior to start of project) of patients (N=2806) indicated that 26% of all codes and 10% of all re-admit to ICUs were respiratory related. Post “Evaluator” project (N=3166), respiratory related codes were decreased to 4%. ICU re-admits secondary to atelectasis were decreased to 3%. Evaluator initiated 53% of all therapies based on assessments and pathway guidelines. Length of stay for all patients who received respiratory treatment decreased by 19.3% (Mean 8.2 to 6.1 days). Furthermore
, the project received an 84% excellent rating vs.16% very good rating with 0% dissatisfaction from the nursing service.

CONCLUSION: By reallocation of existing limited resources, Respiratory Care Department assured consistent and timely patient care. The Evaluator project had direct impact on the number of respiratory related codes, direct impact on the number of ICU readmits secondary to Atelectasis and direct impact on financial savings by reduction in the LOS of patients receiving Respiratory Care. Currently, the Respiratory Care Department is expanding the “Evaluator” service to other units and service lines within the UPMC Presbyterian Shadyside.