2006 OPEN FORUM Abstracts
the use of new technology in eliminating concurrent therapy at a large regional medical center - an analysis of outcomes.
Meyers, Caren BS RRT, Director of Respiratory Care, Hart, Timothy MD, Medical Director
Respiratory Care, WakeMed, Raleigh, NC.
INTRODUCTION
The recent periodic
literature including the AARC position statement regarding concurrent therapy
or "stacking"(2002), takes a clear stand against the practice of stacking;
naming patient safety, quality of care, billing and medication error issues. The AARC white paper and other published
literature, (C.Voss, Advance for MRC,
2003) suggest solutions designed to reduce unnecessary care, and the use of
better technology to increase therapist productivity. CQI processes at WakeMed identified these potential
limitations with existing nebulizer protocols. A new protocol designed to
provide one-on-one care was implemented and based on exploiting the shorter
treatment times available with new breath-actuated technology. This study investigates the practical
viability of this procedural change by examining
the impact on missed treatments pre and post changeover while monitoring other
tracked variables (workload and staffing) that could have interfered with the
result.
Method
In September of 2002, a changeover from conventional nebulizers (Hudson
Misty Nebulizers) to a breath-actuated nebulizer (AeroEclipse®
BAN) was implemented. Concurrently, a
change in practice from stacking to one-on-one therapy was put in place. In June of 2005, 24 months of data representing equal 12-month periods pre and post
procedure change were collected from the hospital information system (Lawson)
and analyzed. Specifically, missed treatments (MT), all respiratory workload
units (RC-WLU), nebulizer workload units (N-WLU), and unfilled FTE's (U-FTE)
were studied.
Results
MT dropped 27% from a mean of
7.4 to a mean of 5.4 between the periods while RC-WLU and N-WLU remained
effectively constant period to period. (See Chart 1 and Table 1) Mean U-FTE's fell from 4.2 to 2.1 between the
periods. Only U-FTE's was significant at
the p<. 05 level.
Table 1
| GROUP | MT | U-FTE | N-WLU | RC-WLU | |
| Pre BAN | Mean N | 7.4 12 | 4.2 12 | 8,514 12 | 69,967 12 |
| Post BAN | Mean N | 5.4 12 | 2.1 12 | 8,667 12 | 68,026 12 |
Pearson correlation of MT with U-FTE's indicated no
significant relationship of this or any of the possible
intervening variables with MT.
Conclusions
Conversion to one-on-one
therapy with the use of breath-actuated technology did not result in an
increase in missed treatments and was likely not a function of suspect
intervening variables. Clinical Implications:
The results of this study appear to offer hospitals a methodology for
eliminating the practice of stacking without increasing missed treatments or having
to hire additional staff. The quality of
care and patient safety improvements that attend automatically to one-on-one
care are a concomitant benefit of this strategy.