Presentation on theme: "Surviving Before Thriving Part II:"— Presentation transcript:
1Surviving Before Thriving Part II: It Hasn’t Gotten Any BetterMichael J Hewitt, RRT, ACCS, NPS, RCP, FAARC, FCCMClinical Manager, Respiratory Care ServicesRhode Island Hospital & Hasbro Children’s HospitalPrincipal Teaching Hospital, The Warren Alpert Medical School of Brown UniversityProvidence, Rhode IslandChair; Respiratory Section, Society of Critical Care MedicineSecretary, Rhode Island Society for Respiratory Care
2Conflict of Interest Disclosures I wish to disclose the following potential conflicts of interest:Type of Potential ConflictDetails of Potential ConflictGrant/Research SupportConsultantSpeakers’ BureausMonaghan Medical, Hollister, IncFinancial supportOther
3Things Haven’t Gotten Any Better Remember This?The Fork In The Road….The Road To Extinction?Surviving & ThrivingThings Haven’t Gotten Any Better
4Let’s Review: The Medical Environment Is Still Changing Reimbursement Structures Are WorsePayor Mixes Continue To Be UnfavorableWe Are Still Under The Microscope
5What’s The Big Deal?Our Problems As A Profession Are NOT The Result Of Or The Fault Of The ACARespiratory Therapy Is Still An Easy Target And It Is Still Our Own FaultIt’s Still All About What Value We Bring To The Table: Now More Than Ever
6Incentive Spirometry, Albuterol & Mucomyst Ain’t It! How Do We Get There?Reminder:Incentive Spirometry, Albuterol & Mucomyst Ain’t It!
7Changing Tradition Is The Key To Our Survival It’s That SimpleOr Is It?
8Payor Mixes Are At Critical Mass Some Real Life Examples:Hospital A: %Hospital B: %Hospital C: %Hospital D: %Where Does Your Hospital Lie?
9Changing Tradition Surgical Patients: Aggressive & Proactive (90% Of All Surgical Patients Get Atelectasis)Medicine Patients: Aggressive & More Effective(COPD Is Now On The 30 Day Readmission Penalties List)
10There’s a Whole New Wave Of Patients On The Way. Who Are They? The Baby Boomers!!(the class of 46-64)aka: The Silver Tsunami69,500,000 Americans Eligible To Retire In The Next 6 Years
11Is This COPD Thing Really A Big Deal? My Own HospitalCOPD Readmissions <30 Days avg. LOS (June 12-July 14):8.44 days actual vs expected (UHC)Average Cost Per Readmission:Floor Admission: $35,268.91ICU Admission: $154,696.00That = Financial DisasterWhere Does Your Hospital Lie?
12So, Now What?We Develop A Plan/Strategy To Decrease These Readmissions:Better And More Effective TherapiesEducation By RT’s (Case Manager Credentialed?)Provide Patients With Better Home DevicesPost Discharge Home Visits By RT’s For First 30 DaysHard Core Data Gathering
17Aerobika* OPEP in COPD and Bronchiectasis OBJECTIVEClinical evaluation of the Aerobika* Oscillatory PEP device in patients with bronchiectasis and COPDOnly COPD patients with chronic bronchitis and/or chronic sputum production were selectedMETHODOLOGYn=29; longitudinal 6 week cross-over study67 (±10) years old; 13 male, 16 femaleCOPD (n=15, aged 65±9, 9 male/6 female)Bronchiectasis (n=14, aged 69±10, 4 male/10 female)Aerobika* Oscillating PEP (3 weeks)/No device (3 weeks)EVALUATION POINTSEach Clinic Visit: spirometry, plethysmography, Six Minute Walk Test, St. George’s Respiratory Questionnaire, 4x daily OPEP administration, Symptom diary, 3He MRI
18Aerobika* Oscillating PEP in COPD and Bronchiectasis COMBINED STUDY RESULTSNumerous patient outcomes were shown to be statistically improved following use of Aerobika* OPEPBreathlessness (dyspnea)Quality of Life (SGRQ measures)Cough FrequencyAbility to ExerciseEase of Bringing up SputumLung FunctionResulting from decreased airway obstruction (improved Slow Vital Capacity%pred)3He MRI revealed changes in lung ventilationIncrease in air transfer from previously unventilated areasDecrease in gas trapping (hyperinflation)No adverse events were recordedSVC (Slow Vital Capacity) – is useful when assessing patients with airway obstruction (eg. COPD) to assess the severity of airway collapse; when improved, shows reduction in airway obstruction
21Even More Opportunities Pre-hospital Rescue CPAP: If You Don’t Have a Tube, You Can’t Get a VAE/VAP.HFOV In Fluid Resuscitated Trauma PatientsThe Role of RT’s in Organ ProcurementWhat Else? We Are Held Back Only By Ourselves
22Let’s Check In With The Students: EMBRACE The Students:Stop Eating Our YoungThe Students Are The Future
23Back At The Fork In The Road Again…. The Road To Extinction?Surviving & ThrivingAre WE (or you) Ready And Willing To Get Past The Fork?
24So, Are We Really In Trouble? Or Am I Just a Lot Of Hot Gas?
25Another Real Life Hospital Example: 5-6 RT’s On Days; 4 On Nights 250 Bed Facility5-6 RT’s On Days; 4 On Nights3 Adult ICU’sTrauma ED
26Typical 12 Hour Shift Workload: 35 (525 minutes) to 60 (900 minutes) scheduled RVU’s7-8 vents, 4-6 BiPAP’s, N.O. administration, infant SiPAP’s, bronch’s, PFT’s yada, yada, yadaNew Issue:Directed to explore replacing RT’s with “trained” non licensed personnel.Is This Value Based?
27If You Need Still More Convincing: Kentucky One Health System, Louisville, Ky:Laid Off 500 People; Eliminating Additional 200 PositionsTurned Over ED Respiratory Functions To NursingThis Includes Treatments, ABG’s, Vent Management, Etc.Nurses Get a 4 Hour “Refresher Class” In Respiratory TherapyHow Did We Get To This?
28And Finally: “But That’s The Way We’ve Always Done It” Remember These Most Expensive Words In Medicine:“But That’s The Way We’ve Always Done It”