Respiratory therapy organizational changes are associated with increased respiratory care utilization.
BACKGROUND
The effect of the respiratory therapist (RT)/patient ratio and RT organizational factors on respiratory resource utilization is unknown. We describe the impact of a multi-component intervention that called for an increase in RT/patient ratio (1:14 to 1:10), improved RT orientation, and formation of a core staffing model on best practice, including spontaneous breathing trials (SBTs) and catheter and bronchoscopically directed lower respiratory tract cultures, or bronchoalveolar lavage (BAL), in both ventilated and non-ventilated patients in the ICU.


METHODS
We conducted a single center, quasi-experimental study comparing 651 patients with single and first admissions between April 19, 2005 and April 18, 2006 before the RT services reorganization with 1,073 patients with single and first admissions between September 16, 2007 and September 4, 2008. Baseline characteristics were compared, along with SBTs, BAL use, lower respiratory tract cultures, and chest physiotherapy.


RESULTS
Patients in the 2 groups were similar in terms of age (52.9 ± 15.8 y vs 53.9 ± 16.4 y, P = .23), comorbidity as measured by Charlson score (2.8 ± 2.6 vs 2.8 ± 2.7, P = .56), and acuity of illness as measured by the Case Mix Index (3.2 ± 3.9 vs 3.3 ± 4.1, P = .47). Mechanically ventilated patients had similar prevalences of respiratory diseases (24.2% vs 25.1%, P = .61). There was an increase in SBTs (0.5% vs 73.1%, P < .001), chest physiotherapy (7.4% vs 21.6%, P < .001), BALs (24.0% vs 41.4%, P < .001), and lower respiratory tract cultures (21.5% vs 38.0%, P < .001) in mechanically ventilated patients post-intervention.


CONCLUSIONS
A multi-component intervention, including an increase in RT/patient ratio, improved RT orientation, and establishment of a core staffing model, was associated with increased respiratory resource utilization and evidence-based practice, specifically BALs and SBTs.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. aparke.36@jhu.edu
Ann M
AM
Parker
Xinggang
X
Liu
Anthony D
AD
Harris
Carl B
CB
Shanholtz
Robin L
RL
Smith
Dean R
DR
Hess
Marty
M
Reynolds
Giora
G
Netzer
D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009936:Organizational Innovation; D010561:Personnel Staffing and Scheduling / Q000639:trends; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000639:trends*; D014600:Utilization Review; D000078329:Workforce