Benefit Associated with Implementation of a Core Respiratory Therapist Team in the Neurocritical Unit

A Core Respiratory Therapist (RT) Team was organized in 2015 to execute the Neurocritical Care Unit Ventilator Protocol and to improve responsiveness to the unique needs of neurological and neurosurgical patients.

Benefit Associated With Implementation of a Core Respiratory Therapist Team in the Neurocritical Care Unit Sumi Campbell, BS, RRT-ACCS1, Kirsten Hallin BSRT-ACCS1, Gregory Hawryluk, MD, PhD, FRCSC2 1) Department of Respiratory Therapy, University of Utah 2) Department of Neurosurgery, University of Utah BACKGROUND A Core Respiratory Therapist (RT) Team was organized in 2015 to execute the Neurocritical Care Unit Ventilator Protocol and to improve responsiveness to the unique needs of neurological and neurosurgical patients. The Core RT Team was stationed within the unit, attended physicians' rounds, and made changes to the ventilator settings in response to abnormal blood gas results. The response time to correct abnormal blood gas results was recorded prior, during, and post-implementation of the Core RT Team in NCCU. A survey was conducted among MDs and RNs prior and postimplementation of the Core RT Team to assess the impact. RESULTS METHODS  Patients in NCCU with diagnosis of CNS or PNS disease at pre-implementation period of August to September 2014, during the transition, January to February 2015, and postimplementation of October to November 2015 were studied.  Intubation duration > 6 h.  A study began with a pH or CO2 level out of range in the blood gas result following intubation and ended when normalized.  The endpoint was extubation or tracheotomy.  The survey was conducted at pre- and post-implementation period among MDs/RNs, and the results were collected in February 2015 and March 2016. A total of 21 MD/RNs responded in 2015, and 30 MD/RNs in 2016.  Patients were assigned a study number that had no PHI associated with. A complete satisfaction level in both RTs' availability and the communication level between MDs, RNs, and RTs. 80% faster response time. CONCLUSIONS  Since the initial implementation of the Core RT Team, the response time has shortened by 80% in the NCCU.  Having an RT physically in the unit and getting the blood gas results to their workphone enabled quicker response time.  NCCU staff survey results demonstrated that creating a Core RT Team has been a beneficial change for the unit. 0 OBJECTIVES To improve vent change response time to abnormal blood gas results for critically ill neurological patients where the normalization of PaCO2 is crucial. To increase communication between MDs, RNs, and the RTs and to assess the perceived impact on patient care by means of a survey. 93% agreed to improved efficacy of the NCCU overall operations by the dedicated Core RT Team. REFERENCES J.K.Stoller, MD. Respiratory therapist-driven protocols. Rationale and efficacy. West J Med 1997; 167:408-410. Amit Banga, MD, Madhu Sasidhar, MD. Respiratory therapist driven protocols for weaning of patients from mechanical ventilation: Experience at a high acuity center with variable patient volumes. Chest Vol 144, issue 4 Oct 2013; 894A, 894B. ACKNOWLEDGMENTS Safdar Ansari, MD Ishwara Sankara, MD Emily Alston, BSN, RN Earl Fulcher, RRT-NPS, MAE Lynnae Napoli, BS, RRT, CCRP Cindy Sparkman, MHA, RRT-NPS Jorell Young Rita Brodzinski, RRT Juan Chavez, BS, RRT Mary Dunlap, BS, RRT-ACCS Ralph Martinez, RRT Rey Mora, BS, RRT-ACCS Te mp l a t e & p ri n t i n g by Me d i ca l G ra p h i cs & P h o t og ra p h y • U n i ve rs i t y o f U ta h Sch o o l o f M e d i ci n e • 8 0 1 . 5 8 7 . 3 4 3 5 / b a rb a ra . s tep h a n @ h s c. u ta h . e d u 8 /2 0 1 2