PURPOSE: Previous studies have shown that RT-driven weaning protocols are associated with improved patient outcomes. The effect of RT: patient ratio and organizational factors on respiratory care resource utilization is unknown. We describe the impact of a multi-component intervention, including a decrease in RT: patient ratio (from 1:14 to 1:10), improved RT orientation and education, and formation of a core staffing model on RT service utilization, including spontaneous breathing trials (SBTs) and catheter- and bronchoscopically-obtained lower respiratory cultures (BALs).
METHODS: We conducted a single center, quasi-experimental study comparing 651 patients with single and first admissions between 4/19/05 and 4/18/06 before the RT services reorganization with 1073 patients with single and first admissions between 9/16/07 and 9/4/08. Baseline characteristics of both groups were compared. We measured and compared SBTs, non-invasive ventilation (NIV) days, nebulizer treatments, BAL use, nasal washings for respiratory viruses, chest physiotherapy (PT), and endotracheal tube (ETT) care.
RESULTS: Patients in the two groups were similar in terms of age (54.7±15.3 vs 55.5±15.8, p=0.43), comorbidity as measured by Charlson score (2.7±2.6 vs 2.9±2.7, p=0.96), acuity of illness as measured by the Case Mix Index (CMI) (4.3±4.9 vs 4.5±4.6, p=0.54) and incidence of respiratory diseases (24.2% vs 25.1%, p=0.61). MICU mortality (30.7% vs 29.3%, p=0.67) and ventilator days (6.4±7.0 vs 7.1±8.9, p=0.20) were similar. There was an increase in SBTs per mechanically vented patient day (0.0±0.1 vs 0.5±0.5, p<0.001), catheter-directed BAL (0.0±0.1 vs 0.1±0.1 p<0.001), chest PT (0.1±0.5 vs 0.4±1.6, p<0.001), nasal washings (0.0±0.1 vs 0.1±0.6, p<0.001), ETT care (0.1±0.2 vs 0.3±0.4, p<0.001), nebulizer use (3.1±4.0 vs 4.0±6.5, p=0.02), and NIV (0.1±0.2 vs 0.1±0.4, p=0.008).
CONCLUSION: A multi-component intervention, including a decrease in patient: RT ratio, improved RT orientation and establishment of a core staffing model, resulted in increased respiratory resource utilization.
CLINICAL IMPLICATIONS: Organizational changes may increase RT utilization and increase the proportion of patients receiving best-care practice.
DISCLOSURE: Ann Parker, No Financial Disclosure Information; No Product/Research Disclosure Information