The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

TIME STUDY ANALYSIS OF CURRENT RESPIRATORY CARE PRACTICE ON CLINICAL NURSING FLOORS

Edward R. Hoisington1, Susan Gole1, Lucy Kester1, James K. Stoller1



Background: The AARC Uniform Reporting Manual was developed to help identify resources necessary to adequately assign and complete Respiratory Therapy (RT) work assignments. Since the 2004 manual, there have been numerous mandates by both the Joint Commission (JC) and Centers for Medicare and Medicaid Services (CMS) which impact the efficiency of RTs' performance. The study intent was to examine the impact these changes have on productivity in our institution.

Methods: We surveyed RT staff members regarding the amount of time they believed should be allotted to the delivery of five basic therapies: small volume nebulizers (SVN), ABG sampling, metered dose inhaler administration, tracheal suctioning, and hyperinflation therapies. A time-motion analysis was performed by following and observing therapists, noting actual treatment times for these five therapies. Time periods began when leaving the previous patient's room and ended when leaving the measured patient's room. These data were compared to both our set departmental standards and AARC Manual standards.

Results: As shown in Table 1, RTs' estimates for performing therapy frequently mirrored departmental standards. Not surprisingly, the actual amount of time spent was higher than allocated for most standards. Ten therapists participated in the survey, there were 68 observations.

Conclusion:

  1. In this small sample study, time-motion analyses show that actual treatment times needed to deliver common RT therapies generally exceed departmental and AARC standards (by up to 33%).
  2. We speculate that two factors may contribute to the variance:
    1. recent mandates require that therapists pull unit dose medications from a secured medication closet (e.g., Pyxis) prior to treating each patient,
    2. common-canister/ multi-patient MDI delivery is no longer practiced. Complying with these mandates increases treatment time. On the other hand, several equipment innovations, e.g. high-efficiency nebulizers, and single-inhalation dry-powder inhalers have contributed to faster treatment.
  3. Our findings suggest the periodic need to reassess time standards for RT treatments, especially as the volume of RT services and the acuity of patients for whom RTs care increase.