CALIFORNIA THORACIC SOCIETY

POSITION PAPER

Respiratory Care At Alternate (Out Of Hospital) Sites

INTRODUCTION

With the changes that are occurring in the health care delivery system increasingly complex care is being delivered to more severely ill patients in settings other than the acute care hospital. These sites include transitional care units, skilled nursing facilities, nursing homes and the patient's home. The ancillary healthcare personnel delivering these services have varying degrees of training. The California Thoracic Society is concerned that some of these personnel are being asked to assess and deliver respiratory care to patients who have problems and needs that the personnel have not been adequately trained to address, presenting a potential risk to the patient. This statement addresses those concerns.

ROLE OF RESPIRATORY CARE PRACTITIONERS

Respiratory Care Practitioners (RCPs) are qualified to assess patients with respiratory problems and to deliver the modalities of respiratory care because of their educational background and training. Although other healthcare providers may possess the necessary training and experience to deliver simple modalities of respiratory care, the RCP is qualified to assist the physician in assessing the overall needs of patients, and recommending and delivering necessary care. This care can be both beneficial to the patient and cost-effective, particularly when done within guidelines of physician-approved respiratory care protocols.

The patients under the care of the RCP are frequently a sicker population than are generally cared for by most other allied healthcare practitioners. RCPs have responsibility for the control of artificial life support equipment and for the assessment of patients with compromised respiratory status. While many of these patients may appear stable, their lack of pulmonary reserve places them in constant jeopardy. The training and the experience of RCPs ensure appropriate care of this fragile patient group.

CONCLUSIONS AND RECOMMENDATIONS

  1. Respiratory Care Practitioners are trained to render respiratory care services both in the hospital and at alternate (out of hospital) sites.
  2. Respiratory Care Practitioners should function under the direction of a qualified medical director both in the hospital and at alternate sites.*
  3. Simple respiratory care services sometimes can be administered by other healthcare practitioners, but these practitioners should be held to the same standards of practice that apply to RCPs.
  4. Complex respiratory services should be administered by or under the supervision of RCPs. Any alternative personnel delivering such care should be subject to:
    1. verification of their education and training,
    2. demonstration of their knowledge and skills by appropriate testing of competency,
    3. licensure under their scope of practice to deliver such care.
*Refer to CTS Position Statement "Medical Director of Respiratory Care Services and Pulmonary Function Laboratories" 1996.

Developed for the CTS Clinical Practice Assembly (CPA) Steering Committee Prepared by Jerrold A. Kram, MD May, 1997 Approved by CTS Executive Committee, 1997

© CTS, 1997

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