Establishing a Telemedicine Respiratory Therapy Service (eRT) in the COVID-19 Pandemic

Pierce, Margie; Gudowski, Steven W; Roberts, Karsten J; Scott, Michael J.; Laudański, Krzysztof

doi:10.1053/j.jvca.2020.11.021

Cited by 9 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Beyond estimating the effect of medication delays for the average ICU patient, an even more powerful model could help providers identify the patient that would benefit the most from a certain medical intervention at any given time. Finally, implementing tele-ICU services as quality control may result in improved medication timing adherence, especially if additional assessment is needed before dispensing the conditional medications [ 42 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

et al. 2021

Self Cite

View full text Add to dashboard Cite

We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse shift changes as disruptors of timely medication (vasodilators, antipyretics, and bronchodilators) delivery to estimate the impact of delay. The average delay around a nurse shift change was 60.8 min (p < 0.001) for antipyretics, 39.5 min (p < 0.001) for bronchodilators, and 57.1 min (p < 0.001) for vasodilators. This delay can increase the odds of developing a fever by 32.94%, tachypnea by 79.5%, and hypertension by 134%, respectively. Compared to estimates generated by a naïve regression approach, our IV estimates tend to be higher, suggesting the existence of a bias from providers prioritizing more critical patients.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…This could be explained by the fact that we simultaneously deployed RTs in our tele-ICU as an extra layer of protection against safety events related to COVID-19. 18 Resource allocation was an important aspect of planning for the initial patient surge. 7,8,10,13 As suggested in Project XTREME, 10 there are 2 approaches to preparing for patient surge.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

BACKGROUND: Staffing strategies used to meet the needs of respiratory care departments during the COVID-19 pandemic included the deployment of respiratory therapist extenders. The purpose of this study was to evaluate respiratory therapist extenders' comfort level with critical care ventilators while caring for patients with COVID-19. To our knowledge, this is the first study to evaluate the deployment of certified registered nurse anesthetists (CRNAs) in a critical care setting. METHODS: A qualitative survey method was used to assess CRNA experience with critical care ventilators. Prior to deployment in the ICU, CRNAs were trained by clinical lead respiratory therapists. Education included respiratory clinical practices and ventilator management. Sixtyminute sessions were held with demonstration stations set up in ICUs for hands-on experience. RESULTS: Fifty-six CRNAs responded to our survey (63%). A mean 6 SD of 9.48 6 12.27 h was spent training prior to deployment in the ICU. CRNAs were at the bedside a mean 6 SD of 73.0 6 40.6 h during the pandemic. While CRNA comfort level with critical care ventilators increased significantly (P < .001) from the beginning to the end of their work experience, no statistically significant differences were found between CRNA comfort based on years of experience. Differences in comfort level were not found after training (chi-squared test 23.82, P 5 .09) or after ICU experience was completed (chi-squared test 5 15.99, P 5 .45). Similarly, mean comfort level did not increase based on the number of hours spent working in the ICU (chi-squared test 5 13.67, P 5 .55). CONCLUSIONS: Comfort level with mechanical ventilation increased for CRNAs working alongside respiratory therapists during the COVID-19 pandemic.

show abstract

“…Here, we describe a deployment of tele-ICU respiratory care services (eRT) in the wake of the COVID-19 pandemic. Our initial report covered some of the aspect of very early implementation but at that time we were not able to produce more in-depth analysis of the implementation [16]. In contrast, here we analyzed the expediency, operational model, and outcomes of eRT deployment on healthcare delivery during the pandemic in a large US healthcare system in much more depth and details.…”

Section: Introductionmentioning

confidence: 99%

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

Pierce

Gudowski

Roberts

et al. 2022

JCM

View full text Add to dashboard Cite

A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT®) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio–visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as “routine” based on established workflows, 4.71% as “urgent”, 0.26% “emergent”, and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient–ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.

show abstract

Establishing a Telemedicine Respiratory Therapy Service (eRT) in the COVID-19 Pandemic

Cited by 9 publications

References 0 publications

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

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

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

Contact Info

Product

Resources

About