2006 OPEN FORUM Abstracts
ROLE OF RESPIRATORY THERAPIST IN ICU OUTREACH: IMPACT OF RESPIRATORY THERAPY TRANSITIONAL SERVICE IN A MAJOR CANCER CENTER
University of Texas-MD
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.