Practice of Respiratory Therapists in Pennsylvania: A Statewide Survey

Abstract

BACKGROUND: The Pennsylvania Respiratory Research Collaborative formed in January 2017 for the purpose of providing mentorship and opportunities to participate in statewide research, quality improvement, and evidence-based practice projects. The inaugural project was designed to investigate and describe the practice of respiratory therapy in Pennsylvania. METHODS: A survey related to the practice and business of in-patient respiratory therapy departments was developed and sent to managers/directors of every hospital within the state of Pennsylvania. The survey period was October 2017 to April 2018. Pennsylvania hospitals were contacted to ask the respiratory therapy manager/director to complete the electronic survey. One hundred eighty-eight hospitals with in-patient respiratory therapy departments were contacted; direct information for the respiratory therapy manager/director was obtained for 159 hospitals. RESULTS: Of the 159 hospitals sent the survey, 101 (63.5%) responded. Of the respondents, 52% were academic medical centers. For staff positions, 50% prefer a bachelor's degree, and 77.3% prefer the Registered Respiratory Therapist certification. However, managers are only able to hire preferred candidates 50% of the time. Clinical ladders are utilized in 29% of the responding institution, and protocols are utilized in 74% of hospitals, with the most common being ventilator (92%), bronchodilator (79%), airway clearance (56%), hyperinflation (41%), and disease-specific (23%). Respiratory therapists in 84% of the hospitals perform nontraditional procedures, with the most common being electrocardiography (35%), advanced procedures including intubation (20%), arterial line placement (14%), blind bronchoalveolar lavage (14%), and electroencephalography (12%). Respiratory therapists are utilized in alternative roles in 42% of hospitals. The most common alternative roles are patient educator (29%), outpatient clinics (21%), patient navigators (19%), transport (14%), extracorporeal membrane oxygenation (6%), case managers (5%), research (5%), and telehealth (2%). CONCLUSIONS: The practice of respiratory therapy in the state of Pennsylvania varies greatly, with a small number of hospitals practicing at the top of their license.

The Rapid Implementation of Ad Hoc Tele-Critical Care Respiratory Therapy (eRT) Service in the Wake of the COVID-19 Surge

“…Traditionally, RTs provide care based on physician orders and pre-existing protocols within the standardized institutional protocols [8]. Interactions and rounding with physicians are crucial aspects of the RT role, in addition to the daily evaluations of the appropriateness of ordered therapies [25].…”

“…ICUs were specialized across COVID-19 (54%) or non-COVID-19 (46%) units. The bedside team on site oversaw patients in a well-established manner, while eRTs provided a consultative service [1,8,9]. The eRTs worked within the framework of the pre-existing teleICU service at PENN E-LERT.…”

“…Furthermore, the pandemic nature of the growth of COVID-19 has further stressed the system by creating a bottleneck in the PPE supply and restricting available medical professionals due to SARS-CoV-2 exposure [7]. Respiratory therapists (RTs) are an integral part of the U.S. healthcare system that increases the capacity of the primary intensive care unit (ICU) teams [8]. COVID-19 presents unique challenges to this service [1,7,9].…”

Evaluation of Respiratory Therapist Extender Comfort With Mechanical Ventilation During COVID-19 Pandemic

“…Although the practice of respiratory therapy has been found to vary between geographic regions, the technical skills are similar (or identical). 15 Some hospitals utilize RTs to the full extent of their license, while others depend on other providers for decision-making while the RTs carry out tasks. 15 Still, RTs remain the clinical experts and first-line assets during times of crisis due to required competencies and their expertise in mechanical ventilation.…”

“…15 Some hospitals utilize RTs to the full extent of their license, while others depend on other providers for decision-making while the RTs carry out tasks. 15 Still, RTs remain the clinical experts and first-line assets during times of crisis due to required competencies and their expertise in mechanical ventilation. 3,16 For these reasons, hospital systems should be selective in deciding what specialty will act as RTEs during patient surges.…”