The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

LEADING CHANGE: ONE DEPARTMENT’S EXPERIENCE IN CREATING A NEW WORKFLOW-PARADIGM.

William Hissner, Joseph Camacci; Penn State Hershey, Hershey, PA

Introduction: To align the mission and values of our Respiratory Therapy department with organizational goals around patient and family satisfaction, patient safety, and length of stay (LOS) at the Penn State Hershey Medical Center (PSHMC), our department spearheaded a hospital-wide change initiative. The initiative involved respiratory therapists (RT) scheduled on site each shift in the emergency department (ED), instead of traditionally being paged in as needed; concurrently RTs would relinquish all hemodynamic-monitoring duties house-wide to bedside Registered Nurses (RN). Background: Since the early 1980’s, RTs at PSHMC have assisted physicians in completing all invasive hemodynamic-monitoring tasks. Also, when RT assistance was needed in our ED, which is designated a Level 1 trauma center, the RN or physician would access us by page as needed—that is, RT staffing was not readily available to provide immediate patient care. Method: First, our RT department offered to assist the ED by dedicating an RT each shift to this area. Next, in order to find the extra time necessary to make on-site RT staffing in our ED a reality, we approached our Interdisciplinary Adult Intensive Care Unit Committee with the proposal of supporting hemodynamic throughout 2010, but commencing 2011 all hemodynamic-monitoring tasks house-wide would be performed by the bedside RN. PSHMC nursing employs a shared-governance model in our four adult-ICUs, with each ICU having both an education and clinical-practice council. It was through these councils which hemodynamic training for RNs was initiated. After one year of house-wide training, each adult-ICU went live with bedside RNs performing all hemodynamic tasks. We then we rolled out our ED initiative which involved having an RT imbedded in this patient care area each shift. Results: The result of having the RT department relinquish hemodynamic monitoring duties’ house wide to bedside-RNs enabled RTs to be in the ED each shift. This resulted in improved patient/family and ED staff satisfaction, and helped alleviate patient-safety concerns surrounding responses to real-time ventilator alarms. Conclusions: Our Shared-Governance model at PSHMC proved very effective in enabling us to change the culture at our organization, aligning nursing and respiratory duties in such a way as achieve organizational goals concerning patient/family and staff satisfaction, as well as patient safety in our ED. Sponsored Research - None