Respiratory therapy organizational changes are associated with increased respiratory care utilization

Ann M. Parker, Xinggang Liu, Anthony D. Harris, Carl B. Shanholtz, Robin L. Smith, Dean R. Hess, Marty Reynolds, Giora Netzer

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The effect of the respiratory therapist (RT)/patient ratio and RT organizational factors on respiratory resource utilization is unknown. We describe the impact of a multi-component intervention that called for an increase in RT/patient ratio (1:14 to 1:10), improved RT orientation, and formation of a core staffing model on best practice, including spontaneous breathing trials (SBTs) and catheter and bronchoscopically directed lower respiratory tract cultures, or bronchoalveolar lavage (BAL), in both ventilated and non-ventilated patients in the ICU. METHODS: We conducted a single center, quasi-experimental study comparing 651 patients with single and first admissions between April 19, 2005 and April 18, 2006 before the RT services reorganization with 1,073 patients with single and first admissions between September 16, 2007 and September 4, 2008. Baseline characteristics were compared, along with SBTs, BAL use, lower respiratory tract cultures, and chest physiotherapy. RESULTS: Patients in the 2 groups were similar in terms of age (52.9 ± 15.8 y vs 53.9 ± 16.4 y, P = 23), comorbidity as measured by Charlson score (2.8 ± 2.6 vs 2.8 ± 2.7, P = 56), and acuity of illness as measured by the Case Mix Index (3.2 ± 3.9 vs 3.3 + 4.1, P = 47). Mechanically ventilated patients had similar prevalences of respiratory diseases (24.2% vs 25.1%, P=61). There was an increase in SBTs (0.5% vs 73.1% P< 001), chest physiotherapy (7.4% vs 21.6% P <.001), BALs (24.0% vs 41.4%, P <.001), and lower respiratory tract cultures (21.5% vs 38.0%, P <.001) in mechanically ventilated patients post-intervention. CONCLUSIONS: A multi-component intervention, including an increase in RT/ patient ratio, improved RT orientation, and establishment of a core staffing model, was associated with increased respiratory resource utilization and evidence-based practice, specifically BALs and SBTs. Key words: personnel staffing and scheduling; critical care; respiratory care units; mechanical ven.

Original languageEnglish (US)
Pages (from-to)438-449
Number of pages12
JournalRespiratory care
Volume58
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • Critical care
  • Health resources
  • Mechanical ventilators
  • Personnel staffing and scheduling
  • Respiratory care units
  • Work load

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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