The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts


Robert B. Vassian, MS, MSIS, MBA, Performance Improvement Department, Mission Hospital, Asheville, NC, Terrance F. Smith, RRT, RCP, BS, Respiratory Therapy Department, Mission Hospital, Asheville, NC, and Kelly Walker, BS, Information Systems Department, Mission Hospital, Asheville, NC

Problem: Mission Hospital spans two hospital buildings and has no way to accurately allocate respiratory therapists (RTs) based on workload. The number of patients requiring respiratory treatments varies daily from 150 to 260 and are seen on most medical and surgical units in the two hospital building complex. The 12-hr shift departmental workload cannot be quantified accurately at either the Respiratory Department or nursing unit level. This makes it difficult for the supervisors to assign appropriate patient loads to individual therapists and has led to exceeding the number of budgeted RT full-time equivalents (FTEs) and overtime hours in addition to incomplete performance of non-patient care responsibilities. With the implementation of a new integrated clinical information system, the department lost the ability to print or view a work-list (on-line) for the RTs to track patients and treatments.

Method: A need assessment based on discussions with Respiratory Department managers and supervisors indicated that the top three issues were: 1) accurate workload estimation based on patient modalities, 2) a concise and usable work-list for distribution to floor therapists and 3) the ability to shift therapists between the two hospital buildings when required by patient need or volume. The Information Systems Department was able to extract all outstanding/incomplete respiratory tasks from the new clinical information system, which included patient information, up to 12 modalities, associated frequency codes, ordering physician, pertinent comments, respiratory classification and classification date. The workload recommendations found in the American Association of Respiratory Care's (AARC) Uniform Reporting Manual were utilized to summarize patient respiratory workload for each nursing unit and subsequently, for each of the two hospital buildings. The Therapist Allocation Program (TAP) was developed using Microsoft Excel and the program calculations followed the AARC recommendation that approximately 70 percent of RT time should be scheduled for direct patient care while the remaining time is utilized for logistics, meetings, etc. Emergent requirements such as scheduled open-heart surgeries and patient transports along with other non-task based considerations such as neonatal intensive care unit oscillators, and the time required for RTs to prepare to treat patients in isolation rooms are incorporated into the model.

Results: Hours worked by RTs performing patient care (including overtime) per patient discharge was selected as the statistic to assess whether there was an improvement in productivity from this project. Data from fiscal years 2000 (prior to TAP implementation) and 2001 (post TAP implementation) were analyzed using the Mann-Whitney test to compare the central location of the test statistic from each period. The null hypothesis was Ho:Median2000 - Median2001 = 0, Ha: Median2000 - Median2001 > 0. The null hypothesis was rejected at the a = .05 level of significance indicating that the there was a statistically significant difference in productivity of the department due to this project. This led to a savings of 7.29 FTEs after implementation. The department experienced an increase in adherence to protocols due to the patient classification and date of classification being visible on the work-list, which was developed with the input of several clinical therapists. The format of the work-list and the TAP on screen therapist allocation recommendations allowed supervisors to readily determine staffing needs by nursing area.

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