Patterns and Factors Associated With Respiratory Care Protocol Use

Metcalf, Ashley Y.; Stoller, James K.; Fry, Timothy D.; Habermann, Marco

doi:10.4187/respcare.03699

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…This reinforces previous research on these phenomena. As Metcalf et al 6 report, greater use of protocols increases RT job satisfaction. Although the survey did not directly ask about job satisfaction, it can be surmised that increasing the status and value of RTs could lead to enhanced job satisfaction.…”

Section: Discussionmentioning

confidence: 89%

“…Protocols have been reported to decrease unnecessary or harmful therapy, healthcare costs, and hospital length of stay while improving resource utilization, effectiveness and appropriateness of care, consistency of care, and patient outcomes, thereby improving the overall quality of patient care. [2][3][4][5][6][7][8] Protocols involving numerous interventions, including oxygen titration, therapeutic interventions, and ventilator weaning, have been described and reported in the literature. [9][10][11][12][13] These studies range from retrospective reviews to randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a β-Agonist/Airway Clearance Protocol in a Pediatric ICU

et al. 2016

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BACKGROUND: Respiratory therapist (RT)-driven protocols have been in use for over 30 years.Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for ␤-agonist and airway clearance interventions where one did not exist. METHODS: This project was composed of 2 parts: a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven ␤-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure. RESULTS: Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the ␤-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre-and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity (P ‫؍‬ .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores (P ‫؍‬ .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, ␤-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics (P < .001) for the therapist-driven protocol group. CONCLUSIONS: In this institution, implementation of a ␤-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU. Key words: respiratory care protocols; therapist-driven protocols; quality improvement; evidence-based medicine. [Respir Care 2017;62(3):259 -267.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Implementation of a β-Agonist/Airway Clearance Protocol in a Pediatric ICU

et al. 2016

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“…The recruitment of hospitals and participating RTs and managers and the deployment of the online surveys were as described previously. 5 In brief, collected data elements included RTs' perceptions of job satisfaction, turnover intentions, and job stress. Managers were queried regarding the level of protocol use within each participating hospital unit.…”

Section: Samplementioning

confidence: 99%

“…Because employees' perceptions and experiences in their jobs have been shown to affect productivity and performance, 4 respiratory care managers must consider how work design impacts RT job satisfaction and turnover intentions. A previously reported multi-hospital, survey-based report regarding determinants of respiratory care protocol use 5 provides the basis for this more detailed analysis of the impact of respiratory care protocol use on RT job satisfaction and turnover intentions. Specifically, we examine the effect of respiratory care protocol use on RT overall job satisfaction, turnover intentions, and perceived job stress.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Therapist Job Perceptions: The Impact of Protocol Use

et al. 2015

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BACKGROUND: Demand for respiratory care services and staffing levels of respiratory therapists (RTs) is expected to increase over the next several years. Hence, RT job satisfaction will be a critical factor in determining recruitment and retention of RTs. Determinants of RT job satisfaction measures have received little attention in the literature. This study examines the use of respiratory care protocols and associated levels of RT job satisfaction, turnover intentions, and job stress. METHODS: Four-hundred eighty-one RTs at 44 hospitals responded to an online survey regarding job satisfaction, turnover intentions, and job stress. Random coefficient modeling was used for analysis and to account for the nested structure of the data. RESULTS: Higher levels of RT protocol use were associated with higher levels of job satisfaction, lower rates of turnover intentions, and lower levels of job stress. In addition, RTs with greater experience had higher levels of job satisfaction, and RTs working at teaching hospitals had lower rates of turnover intentions. CONCLUSIONS: The study extends prior research by examining how the use of respiratory care protocols favorably affects RTs' perceptions of job satisfaction, turnover intention, and job stress. In a time of increasing demand for respiratory care services, protocols may enhance retention of RTs.

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“…The authors identify that physician support is a characteristic found in centers that use protocols, as is use of high-quality information systems. The work by Metcalf et al 14 falls short in providing the reader with information on why protocols fail to be widely adopted. Although further investigation may yield such detail, the respiratory care community has a new incentive to consider the use of protocols.…”

mentioning

confidence: 99%

Therapist-Driven Protocols: New Incentives for Change

Ford

2015

Respir Care

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Patterns and Factors Associated With Respiratory Care Protocol Use

Cited by 12 publications

References 17 publications

Implementation of a β-Agonist/Airway Clearance Protocol in a Pediatric ICU

Implementation of a β-Agonist/Airway Clearance Protocol in a Pediatric ICU

Respiratory Therapist Job Perceptions: The Impact of Protocol Use

Therapist-Driven Protocols: New Incentives for Change

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