The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

ROLE OF RESPIRATORY THERAPIST IN ICU OUTREACH: IMPACT OF RESPIRATORY THERAPY TRANSITIONAL SERVICE IN A MAJOR CANCER CENTER

Marion Bolden BSRC, Clarence G. Finch BS, BA, RRT, S. Egbert Pravinkumar MD, FRCP, FCCP, Delores Mejia RRT, Joseph L. Nates, MD, MBA, FCCM, Kristen Price MD, FCCP.

University of Texas-MD Anderson Cancer Center, Houston, Texas

Background: Respiratory diseases are the major reason for ICU readmissions, and prompt respiratory therapy in post ICU setting may significantly decrease the need for early readmission. Since critically ill patients' organ functions are stabilized but not necessarily normalized prior to transfer out of ICU, optimal care should be continued on the floor or in an intermediary care setting. We studied the impact of a devised, respiratory therapist assessment score (RTAS) and evaluated the effect of a respiratory therapy transitional service (RTTS) on ICU readmission rates in this comprehensive cancer center.

Methods: All patients discharged from medical and surgical oncological ICU between 1/1/2004 and 12/31/2004, and who underwent at least 24 hours of mechanical ventilation or non-invasive positive pressure ventilation and patients discharged with a FiO2 requirement of >0.4  were included in this study. The patients were followed in the floor by dedicated therapists in the RTTS. Patients discharged between 1/1/2004 to 6/30/2004, pre-RTTS, served as controls (Group A) and between 7/1/04 to 12/31/2004, post-RTTS were the study Group (Group B). The RTAS was used to evaluate and categorize severity and follow-up visits. Patient data and outcomes were recorded in the respiratory care database as part of quality assurance program. Changes made to initial respiratory therapy orders following RTTS follow-up were also recorded.

Result: A total of 3113 patients were discharged from ICU during the study period; 1505 in Group A (Pre RTTS), and 1608 in Group B (Post RTTS). Of the 1608 patients in Group B, 240 patients met criteria for RTTS follow-up. During the study period, a total of 112 patients (3.6%) were readmitted to the ICU and 60 of them (1.9%) due to respiratory causes. The ICU readmission due to respiratory causes pre and post RTTS implementation were 58 (97%) and 2 (3%) respectively. Total changes made by RTTS team to the initial respiratory therapy orders in the floor were 59%.

Conclusion: Implementation of RTAS and RTTS to evaluate and manage respiratory issues in patients discharged from ICU had a major impact in the readmission rate, resulting in 94% decline in ICU readmissions due to respiratory causes. These interventions and their results have significant implications in patient care, resource utilization, and outcomes.  

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