Respiratory Care Services

Transcription

1 Respiratory Care Services Who we are 45 Licensed Respiratory Care Practitioners & 3 per diem Hospital assistants Out patient services Limited to Asthma Clinic Pilot In-patient services Primarily intensive respiratory care Critical Care Units ED MERT Code Blue NICU Transport of critical care patients to diagnostic areas

2 Inpatient Services Ventilator management Ventilation perfusion analysis Blood gas procurement and analysis Metabolic analysis Non-invasive ventilation management O2 and aerosol therapy Aerosolized medication delivery Resuscitation Patient consultation and assessment

3 Education Contributions Nursing Staff Annual update New hire orientation Conscious sedation airway management Just in time education for NT suctioning, tracheal care, NIV ICU Medical Staff Ventilator lecture ARDS-Net Protocol Community Clinical affiliate for RT students Annual Selected Topics in Respiratory Care

4 Performance Measure 1: Non-Invasive Ventilation Aim: To decrease the rate of reintubation by 50% among COPD patients using Non invasive ventilation after extubation by March 31, 2010 Measure # of COPD Patients receiving NIV reintubated within 48 hours Change in Process ID COPD patients on a daily basis - Attending physician and RCP collaboration Encourage rapid extubation from a successful spontaneous breathing trial (SBT) and implementation of NIV at minimal settings Challenges Variable weaning and extubation practices among Faculty Screening and NIV implementation decreased in December-March What we found While NIV was not always initiated soon after extubation, simply initiating NIV did not always prevent reintubation. However the reintubation rate and the average length of intubation for COPD patients decreased.

5 Results 2008: 17% of COPD patients were reintubated within 48 hours 20% of COPD patients received NIV post extubation Average Length of Intubation: 4.7 days March 2010: 8% of COPD patients were reintubated within 48 hours 36% of COPD patients received NIV post extubation Average Length of Intubation: 3.6 days NIV Initiated Reintubated < 48 hours Reintubated p NIV 4.7 LOI Patients patients

6 Performance Measure 2: Chest Asthma Clinic based RCP Background: Asthma Clinic was staffed by 1NP who performed Spirometry (FEV1/FVC), provided disease and medication education, and smoking cessation. Aim: By March 2010, improve access to spirometry, education, and tobacco cessation for asthma patients in the Chest Asthma Clinic at SFGH, and improve provider satisfaction with outpatient respiratory care services. Measures: # of asthma patients seen per week by RCP % of providers who respond strongly agree to provider satisfaction survey Changes We assigned a RCP in the clinic one day per week Respiratory Care Practitioner (RCP) oriented to the Clinic by the Nurse Practitioner. RCP was trained to perform: Basic Spirometry E-NO testing Patient Education on the disease process and medication management of asthma and COPD Process Changes 3 more RCPs are orienting to the Asthma Clinic Increase RCP presence from 1 to 2 Asthma Clinics per week Encounter form changed to include RCP services

7 Chest Clinic Provider Survey-11 respondents 100% 80% 60% 40% 20% 0% Increased access to studies and services RCP in Asthma Clinic Improved your ability to make care decisions Improved Patient Flow Are you staisfied with RCP services Strongly Disagree Disagree Neutral Agree Strongly Agree Other Comments RCPs are extremely professional & helpful We all fortunate to have them with us Much needed addition and resource for our clinic Incredible Asset! Improve patient flow and a time saver # Patients seen in the Wednesday Asthma Clinic Prior to Pilot February March 2010 Average 3-5 Patients Average 8-10 Patients

8 Other / On-going Projects Spontaneous Breathing Trial Protocol in relation to Length of Intubation and Incidents of VAP Airway Assessment ALI/ARDS Mortality Critical Alarm Volume and Audibility Missed Medications Hand Hygiene Unexpected Extubations Critical Values reporting