Respiratory care manpower issues

Mathews, Paul J.; Drumheller, Lois; Carlow, John J.

doi:10.1097/01.ccm.0000203103.11863.bc

Cited by 19 publications

(17 citation statements)

References 6 publications

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“…The presence of a pharmacist in the ICU has been associated with reduced mortality, adverse events, infections, and drug charges (61–65). The effect of changing the respiratory therapist:patient ratio has not been previously evaluated; expert opinion suggests that the optimal ratio of patients to respiratory care practitioners is between 9:1 and 11:1 (66). This may facilitate increased use of patient-oriented, respiratory care-driven protocols (67–70).…”

Section: Discussionmentioning

confidence: 99%

Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit

Netzer¹,

Liu²,

Shanholtz³

et al. 2011

Critical Care Medicine

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Objective To evaluate whether a multicomponent intervention, particularly increasing staff, can achieve reductions in patient mortality in an already high-intensity, Leapfrog-compliant medical intensive care unit. Design Retrospective, observational study. Setting Medical intensive care unit of a tertiary care, academic medical center. Patients A total of 1,263 patients admitted between April 19, 2004 and April 18, 2006 (before the organizational change) were compared with 2,424 patients admitted between September 5, 2006 and September 4, 2008. Interventions A multicomponent intervention including the physical move from a 10-bed to a 29-bed medical intensive care unit with larger patient rooms, the initiation of 24-hr critical care specialist coverage in the medical intensive care unit, an increase in the respiratory therapist:patient ratio, and the addition of a clinical pharmacist to the multidisciplinary team. Measurements and Main Results Measurements were made based on mortality in the intensive care unit and in-hospital. Patient comorbidity as measured by the Charlson score did not change after the intervention (2.7 ± 2.7 vs. 2.8 ± 2.6, p = .62), nor did the acuity of illness as measured by the case mix index (3.0 ± 3.7 vs. 3.1 ± 3.8, p = .69). The unadjusted medical intensive care unit mortality decreased from 18.4% to 14.9% (p = .006), as did in-hospital mortality (from 25.8% to 21.7%, p = .005). The reduction in medical intensive care unit mortality was consistent in the multivariable regression with adjustment for multiple possible confounders (odds ratio = 0.74, 95% confidence interval: 0.61– 0.91, p = .003), as was the reduction in hospital mortality (odds ratio = 0.74, 95% confidence interval: 0.62– 0.88, p = .001). In mechanically ventilated patients, there was an increase in median 28-day ventilator-free days (21, interquartile range 0 –25 vs. 22, interquartile range 0 –26, p = .04). An increase in median medical intensive care unit (2.4, interquartile range 1.1–5.2 vs. 2.7, interquartile range 1.3–5.9), p = .009) but not hospital (8.3, interquartile range 4.1–17.0 vs. 8.2, interquartile range 4.0 –16.8; p = .851) length of stay in days occurred with the intervention. The mean daily dosing of fentanyl and lorazepam decreased after the intervention. Conclusions A multicomponent reorganization of medical intensive care unit services was associated with important reductions in mortality for medical intensive care unit patients, as well as an increased number of ventilator-free days. Substantial and sustained changes in clinically important outcomes may be obtained from organizational changes.

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Section: Discussionmentioning

confidence: 99%

Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit

Netzer¹,

Liu²,

Shanholtz³

et al. 2011

Critical Care Medicine

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“…A 2006 study, surveying RTs at 30 hospitals ranging in bed size from Ͻ 250 to Ͼ 500 beds, concluded that increased RT staffing would be necessary if ICUs continued to grow as projected. 27 A recommendation was made that one new RT be hired for every 11.3 beds added to an ICU, in order to maintain appropriate patient care. 27 Our study found that an improved RT staffing ratio of 1:10 (increased from 1:14) was associated with increased utilization of best-evidence practice in the care of mechanically ventilated patients.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization

Parker

Liu²,

Harris³

et al. 2013

Respir Care

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There was an increase in SBTs (0.5% vs 73.1%, P < .001), chest physiotherapy (7.4% vs 21.6%, P < .001), BALs (24.0% vs 41.4%, P < .001), and lower respiratory tract cultures (21.5% vs 38.0%, P < .001) in mechanically ventilated patients post-intervention. CONCLUSIONS: A multi-component intervention, including an increase in RT/ patient ratio, improved RT orientation, and establishment of a core staffing model, was associated with increased respiratory resource utilization and evidence-based practice, specifically BALs and SBTs.

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“…In contrast, the organizational model in the United Kingdom does not include respiratory therapists, thus organization and context must be considered when comparing nurse to patient ratios in other countries. 26 In the absence of respiratory therapists in the United Kingdom, it is essential that PICU nurses be used effectively and efficiently within the interprofessional team to manage the weaning process. Protocols assist bedside nurses in making decisions about the frequency and appropriateness of weaning and, in an adult ICU study, nurses found that protocols provided uniformity and safe guidance in weaning practice.…”

Section: Professional Responsible Senioritymentioning

confidence: 99%

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Blackwood¹,

Junk²,

Lyons³

et al. 2013

American Journal of Critical Care

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Background Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. Objective To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation. Methods Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom. Results Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training. Conclusions Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.

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Respiratory care manpower issues

Cited by 19 publications

References 6 publications

Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit

Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit

Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

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