Egan’s chapter-2

What are the elements of respiratory care department?
Medical director
respiratory therapists
technical director
Medical directors and their roles
– usually a pulmonary / critical care physician or anesthesiologist
-He owns a full time responsibility, and should be available on 24 hour basis for consultation.
-Must have medical as well as administrative skills.
– Department can have autonomy under the supervision of medical director.
-They can educate other people like doctors and nurses about the role of respiratory therapists
– help in promotion of the technical standards of the staff.( in services and training programs)
take care of departments budget.
designations and credentials of respiratory therapists
1) CRT- certified respiratory therapist
2) RRT- registered respiratory therapist
Which organization is working for the future development of graduate education in respiratory care?
-American association of respiratory care (AARC)
– both current and under developed programs.
Who reviews the respiratory care education program?
Committee on Accreditation for respiratory care(Co ARC)
Who sponsor CoARC?
4 organizations
– AARC= american association of respiratory care
– ACCP= American college of chest physicians
– ASA= American society of Anesthesiologists
-ATS= American thoracic society
Credentialing
It is a general term that refers to the recognition of individuals in particular occupation or profession
what are the 2 form of credentialing in health care field?
– State licensure
– voluntary certification.
Licensure
is the process in which government agency gives an individual permission to practice an occupation.
– license is granted only after the verification that applicant has demonstrated the minimum competency necessary to protect the public health safety or welfare.
Certification
-Voluntary non government process, whereby a private agency grants recognition to an individual who has met certain qualification.
-eg graduation from a approved educational program.
which organization ensures quality in respiratory care in voluntary certification or registration conducted?
NBRC
National Board of Respiratory Care.
it is an independent national credentialing agency for the people who work in respiratory care.
which organizations sponsor NRBC
AARC,ACCP, ATS,ASA and National society of pulmonary technology.
Who forms the board for NRBC?
representatives from all these societies.
When does the AS degree started
2006??????????
Which is an additional license for working in pediatrics?
NPS( neonatal/pediatric specialist)
-This is an additional advance level credential.
What other credentials does NRBC provide?
CPFTs- certified pulmonary function technologists
RPFTs-registered pulmonary function technologists
Professionalism
is characterized as an individual conforming to the technical and ethical standards of the profession.
Professional characteristics of a respiratory therapist
-completes accredited respiratory therapy program
-Obtains professional credentials
– participate in continous CME
– Adheres to the code of ethics put forth by the institutions or state licensing board or both
-join professional organizations.
Who has responsibility as technical director of the department?
It is the responsibility of the manager
– He must ensure that the equipment and associated quality, safety, health and welfare of the patient using the equipment.
-Technical director must ensure that new devices, methods and strategies not only are effective but also deliver a benefit compensated with cost.
Under which act does medical devices are regulated?
Medical device amendment law of 1976, under the authority of FDA
FDA regulates the drugs delivered by RTs
It ensure that procedures and protocols related to the use of equipment and medication must be written to provide guide for the respiratory care staff.
What is an another name of the respiratory care protocol?
Therapist driven protocols.
These are the guidelines for delivering appropriate respiratory t/t care and services
– protocols are written in form of algorithm
What is the key of success of a respiratory care protocol?
-Active and committed medical direction
-Capable RT’s
– Collaboration with physicians and nurses.
– responsible hospital environment
when does hospital accepts the RT protocols?
When protocols enhance patient care
– Improve allocation of respiratory services and reduce cost.
-Physicians accept for the good will of patients and when they trust in the quality, professionalism and competence of the respiratory therapy staff.
– Nurses will accept when they persuaded that protocols will enhance the efficient care and help relive excess nursing workload
– upon the ownership of the protocols
respiratory therapy consult service
A comprehensive approach of using protocol is to combine specific protocols to form respiratory therapy consult service
Also called an evaluate and treat program.
what are the strategies to monitor quality?
-Intrainstitutional monitoring practices
-centralized government monitoring bodies
* centers of medicare
* medicaid services
– voluntary agencies like TJC
TJC
The Joint commission
– formed in 1951
by American college of surgeons, the American hospital association and AMA
– They want that hospitals should provide with quality assurance plan to provide
TJC Standard of performance improvement
– The hospital collect data to monitor its performance
– The hospital compiles and analyzes the data
– The hospital improves performance on an ongoing basis.
what are the quality monitoring bench marks
-Monitoring the correctness of respiratory care plan
-Monitoring the consistency of formulating respiratory care plan among therapist evaluators
-Evaluating the efficiency of algorithms or protocols
– Evaluating the overall effectiveness of the protocol program.
One method of monitoring used for respiratory therapy
case study exercise
– these stimulated patients exercise can help determine the consistency of respiratory care plan among therapist evaluators.
consists of 3-4 patient scenarios
everybody work on those scenarios and then those are compared with the gold standard
If the particular therapy has consistently large number of associated errors, the algorithm is viewed for errors and weakness.
PROs
-Peer review organizations
-elaborated system established by the federal government
– It helps to evaluate the quality and appropriateness of care given to medicare beneficiaries.
Cross training
-Is an another aspect of restructuring and redesigning personnel and using assistive staff.
– can be attempted by teaching activities( on job training of unlicensed people). they have a basic medical background in the health care.
this strategy has fallen into disfavor because of the substantial associated challenges in implementation.
why protocols are required for respiratory therapy practice?
The primary purpose is to provide therapy to patients needing and likely to benefit from therapy but to avoid delivering services to patients not likely to benefit.
– This provides a dynamic system for modifying the respiratory care regimen in response to a patients changing clinical condition.
– reduces misallocation of respiratory care
Disease Management
refers to an organized strategy of delivering care to a large group of individuals with chronic disease to improve the outcome and reduce the cost.
– this is systemic population based approach.
components of disease management program
1) Integrated health care system that can provide the coordinated care across the full range of patient needs.
2)comprehensive knowledge base regarding prevention, diagnosis and treatment of disease that guides the plan of care
3)Sophisticated administrative and clinical information system that can help to access patterns of clinical practice
4) Commitment to continuous quality improvement.
Evidence based medicine
Refers to the approach to determining optimal clinical management based on several practices.
What are those practices? for evidence based medicine
-Rigorous and systemic view of available evidence.
-Critical analysis of available evidence to determine what management conclusions are more sound and applicable
-a disciplinary approach to incorporate the literature with personal practice and experience.
Various designs and type of studies from which the scientific evidence comes
1) single case report
2)Case series
3) Cohort studies
3a) Observational cohort studies
3b)Randomized controlled trials
Single case report
-Clinical issue or problem describes only one patient.
– It can give us new insight and new possibilities for treatment, disease association and disease pathology
-but the effectiveness of the treatment or the causality of a risk factor because they by nature , lack of control or comparison group.
– people with rare disease
Case Series
collecting group of patients with similar clinical feature
– they have greater impact than single case report
– however they also cannot prove efficiency of treatment or casualty of the risk factors because no comparison or control group included.
Cohort studies
which compare the clinical outcomes in two compared groups( or cohorts)
Have greater scientific rigor
2 types
observational cohort studies
randomized controlled trials
observational cohort studies
Compare the outcome between 2 group of patients, when the treatment was allocated to one group and not other because of physicians order or by patients choice.
Randomized controlled trials
regarded as the most methodologically rigor designed study, when well conducted.
Will compare the outcome of two similar groups.
eliminates all source of bias
Variants of randomized controlled trails
-parallel control study
– cross over study
Parallel control study
2 groups being studied; one receive the t/t being studied and the other receive the control t/t
The cross over trail
t/t is 1st administered to one group, while other receives control or comparison t/t and after measuring outcome and washout. T/t is given to the opposite group.
It offer statistical advantage
washout period
In which the effect of the initial treatment decay and wear off fully.
meta analysis
Systemic viewing of available literature.
Narrative analysis
the meta analysis which simply evaluate the quality of the data from each available trial.