The Science Journal of the American Association for Respiratory Care

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.


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.

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.

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

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.

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. 

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