Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions

Abstract

BACKGROUND: The purpose of this retrospective medical record review was to report on recidivism to the ICU among adult postoperative cardiac and thoracic patients managed with a respiratory therapy assess-and-treat (RTAT) protocol. Our primary null hypothesis was that there would be no difference in all-cause unexpected readmissions and escalations between the RTAT group and the physician-ordered respiratory care group. Our secondary null hypothesis was that there would be no difference in primary respiratory-related readmissions, ICU length of stay, or hospital length of stay. METHODS: We reviewed 1,400 medical records of cardiac and thoracic postoperative subjects between January 2015 and October 2016. The RTAT is driven by a standardized patient assessment tool, which is completed by a registered respiratory therapist. The tool develops a respiratory severity score for each patient and directs interventions for bronchial hygiene, aerosol therapy, and lung inflation therapy based on an algorithm. The protocol period commenced on December 1, 2015, and continued through October 2016. Data relative to unplanned admissions to the ICU for all causes as well as respiratory-related causes were evaluated. RESULTS: There was a statistically significant difference in the all-cause unplanned ICU admission rate between the RTAT (5.8% [95% CI 4.3-7.9]) and the physician-ordered respiratory care (8.8% [95% CI 6.9 -11.1]) groups (P ‫؍‬ .034). There was no statistically significant difference in respiratory-related unplanned ICU admissions with RTAT (36% [95% CI 22.7-51.6]) compared with the physician-ordered respiratory care (53% [95% CI 41.1-64.8]) group (P ‫؍‬ .09). The RTAT protocol group spent 1 d less in the ICU (P < .001) and in the hospital (P < .001). CONCLUSIONS: RTAT protocol implementation demonstrated a statistically significant reduction in all-cause ICU readmissions. The reduction in respiratory-related ICU readmissions did not reach statistical significance.

From Here to There: Vision, Value, and the Advancement of Respiratory Care

“…There is ample and growing evidence that respiratory therapists are in an enviable position to contribute value to health-care delivery in a variety of ways, including patient-centered protocols, 11 disease management, 12,13 telehealth 14 and discharge planning, 15 to name just a few. The article by Dailey et al 1 illustrates the value respiratory therapists can have in the expansion of respiratory care and the immediate impact they can have on patient care. The ripple effect these kinds of interventions have on health care ultimately extends beyond simple patient outcomes to work flows and processes in the continuity of care for the patient, efficiency within the organization, and cost reduction.…”

“…That's why moving our profession from here to there will require influential practitioners who can articulate the collective vision for respiratory care and demonstrate the value of our profession in whatever practice settings they encounter. In this issue of RESPIRATORY CARE, the article by Robert Dailey et al 1 illustrates how respiratory therapists can bring value to the bedside and advance the profession within their sphere of influence.…”

Respiratory Care Education and Clinical Practice in Mainland China

“…Respiratory therapists (RTs) have worked as independent professionals for more than 70 years in the United States, and the effectiveness of RTs in mechanical ventilation, aerosol therapy, performing mini-bronchoalveolar lavage, and implementing respiratory care protocols to wean patients from mechanical ventilation has been shown. [1][2][3][4][5][6] However, in many countries, respiratory therapy has not been accepted as an independent profession in the medical field. The recognition of RTs is still in a transitional phase in some countries, such as mainland China, 7 Germany, 8 and the United Kingdom.…”