The February issue of AARC Times introduced readers to the WellStar Health System, a five hospital group in Georgia in the process of implementing respiratory care protocols. Over the next year, we’re going to follow the system here on the Web as it proceeds through that process, checking in with RT managers every few months to see how things are going. In this installment, we pick up the thread as the first two sites take protocols from the “evaluate-and-suggest” phase to “evaluate-and-treat.”
Installment 1:
The Protocol Diaries: First Sites Goes LiveInstallment 2:
The Protocol Diaries: Meeting ExpectationsInstallment 3:
The Protocol Diaries: Holding Their OwnInstallment 3:
The Protocol Diaries: The Final Edition
Share Your Encouragement
Send a letter of encouragement or share your stories of protocol implementation. We may choose to publish your letter online.
Your Responses:
Congratulations to the Terri and her crew with the Wellstar Health Group on taking the professional leap into protocol land. We too survived and now thrive in a fully implemented automatic assess and treat protocol program. We are in year 6 of our process and are housewide, including the intensive care units (minus NICU). Almost all of our 300+ physicians love the program and rely on us to have their patient's respiratory status maximized. Our biggest hurdle was our own staff resisting making the change from task performers to decision makers. Medical Exec committee passed our protocol program as an automatic with any respiratory order written by the physician about 3 years ago. We do allow the physician to “opt out” of protocols but they have to write an order to do so, otherwise we write orders for their patients.Keep up the good work. The key for us it is taking care of the little stuff—putting out the fires with unhappy physicians or nurses and making sure our staff know that 99% of the time, the physicians love what we do. We encourage our staff to not focus on the 1% or less who disagree with what we’ve done. I remind physicians, our staff and administration often of the $350,000 per year that we are saving by not doing therapy without indications.
Ruth Krueger
I would like to say -- WOW! It sounds like this theory, which is being implemented across several hospitals, is starting to work. Congratulations. I am a respiratory therapist in Duluth, MN, at a 200+ bed facility. We are in the primary stages of discussing TDP's for several of our duties within our hospital. Last July, we finally hired a pulmonologist, and this spring, we are adding a sleep lab to our facility. My hopes, in assisting our nurse manager (who oversees the respiratory department), is to convince her that we can use TDP's in our hospital. I am using you as a first example. We currently attain 20 or so therapists instead of the 177 combined that you have in your facilities, so I am hoping that the training won't be as time-consuming. Our pulmonologist seems excited to move forward as well. The issue lies in someone to help redo/revise our policies (I am the only 'volunteer' so far). If you could e-mail me with any examples of your protocols so I can show them how this is working in other hospital/clinic settings, I feel that it may be the push to get the wheel rolling. Again, I am sincerely happy that respiratory therapists are starting to be recognized professionally as part of the medical team that can contribute efficiently and effectively with patients who require our assistance. Thank you for your time.
Debbie Leland, BA, BAS, CRT
We implemented a pilot Respiratory Care Protocol Service as of August of 2002 on our Skilled/Rehab floors. The Respiratory Medical Director and the respective Medical Directors of both areas has encouraged and supported us from the start. This was a smaller area but had been pin-pointed as an area for possible large savings.
We held meetings for the nursing staff involved to explain and answer questions about the program. Our director also outlined the protocols and its benefits to our senior medical committee. The department also inserviced the Respiratory staff not directly involved with the pilot program to educate them on respiratory protocols.
We chose to start with a small core group of staff that showed an interest to do the evaluations. We had extensive training and practice evaluations for 3 plus months before initiation. Education also included a 5 hr education assessment course and a skills check off sheet.
We based the majority of our protocols on Cleveland Clinics program. JK Stoller MD and L Kester RRT FAARC both were extremely helpful in helping get our program off to a solid start. All this led to an interest in having a website that has an area dedicated to protocol information as a starting point for other respiratory programs interested in protocols. http://www.iowarespiratory.com/
We have passed our six month of protocol services and the results have been outstanding. We are doing follow up on hospital savings and patient outcomes. We have an on-going QA program to check for errors/problems, to educate staff and for possible protocol changes.
We hope to follow this up by introducing this service to the general hospital floors.
8/01/02 to 02/01/02
(Six Month Respiratory Protocol Summary)
Total patients - 130
Total evaluations - 169
Total initial evaluations with decrease in TX freq - 81
Total initial evaluations with increase in TX freq - 13
Total initial evaluations that stayed the same - 41
Total decrease in number of treatments - 205
Average length of stay of patients followed in Skilled/Rehab - 11 days
Average cost per TX - $40.00 X 1.58 TX PER DAY SAVINGS
Average per day/per patient savings - $63.20
Savings per patient times average length of stay - $695.20
Total 6 month savings - $ 90,376
Anticipated savings for 1 year - $180,752
Percent of treatment decline per the protocol - 47% decrease in treatments
QA/Comments
Total mistakes by evaluators -- 5 --- a 2.9% error rateWe continue to see the same results as mentioned in our 2 month report on patient safety, patient outcomes and the protocols effectiveness. So far physician acceptance has been extremely encouraging in Skilled/Rehab.
Ken Darby RRT
