aarc barriers to protocol implementation survey results a project of the aarc protocol...
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AARC Barriers to Protocol ImplementationSurvey Results
A Project of the AARC Protocol Implementation Committee
2008
Slides developed to adjunct lectures supporting the use of respiratory care protocols
Survey Background
• In order to better develop a plan for the implementation and use of protocols the committee recognized that barriers exist
• Survey tools were developed to assess these barriers and perceptions
• Separate surveys were developed for both the Manager and Staff Therapist
• This slide presentation was developed from those surveys and is intended to assist in understanding the barriers and developing successful strategies to implement protocols
Protocol Definition
• For the purpose of both the Manager and Staff surveys, protocols were defined as: – Initiation or modification of a patient care plan
following a predetermined structured set of physician orders, instructions or interventions in which the therapist is allowed to initiate, discontinue, refine, transition, or restart therapy as the patient's medical condition dictates.
• Note: This definition should not be confused with programs that include discontinuation of therapy without a reorder, flagging therapy for physician reorder, standing orders or policies that dictate therapy durations.
Respondents Region - Manager Survey
459 respondents (post cards and email)
In which U.S. census region is your hospital located?
New England
Middle Atlantic
East North Central
West North Central
South Atlantic
East South Central
West South Central
Mountain
Pacific
Demographics – Manager Survey
Location of your hospital
0%
5%
10%
15%
20%
25%
30%
35%
40%
1
Rural
Suburban
Urban
Hospital Type - Manager Survey
Describe your hospital's type of ownership
0% 10% 20% 30% 40% 50% 60% 70%
Government-Non-Federal
Government-Federal
Non-Government not-for-profit
Investor owned (for-profit)
Number of staffed beds supported by your hospital
27%
23%
26%
24%
21% 22% 23% 24% 25% 26% 27% 28%
Less than 100
101-200
201-400
401 or more
The majority were not forprofit hospitals
Evenly split betweensmall and large hospitals
Department Profile - Manager SurveyWhat is the total number of respiratory therapist FTEs?
0%
5%
10%
15%
20%
25%
30%
35%
Less than 10 11 25 26-50 51-75 76-100 More than 100
Does your hospital have protocols in place as described in the definition above?
Yes
No
Mostly hospitals with < 25 FTEs
The majority have at least one protocol as described
Protocol Use - Manager Survey
Does your hospital have protocols in place as described in the definition above?
0% 10% 20% 30% 40% 50% 60%
1 to 5
5 to 10
More than 10
What is your estimate of the percent of respiratory therapy provided by protocol at your institution?
0% 5% 10% 15% 20% 25% 30% 35% 40%
0-25
26-50
51-75
76-100
Not applicable
The majority of hospitals do not have a comprehensive protocol program.
Less than 50% of care is provided by protocols despite the evidence that protocols improve outcomes and reduce cost.
Types of Protocols in Place - Manager Survey
64%
37%33%
50%
24%
58%
20%
0%
10%
20%
30%
40%
50%
60%
70%
Oxygen Bronchialhygiene
Lunghyperinflation
Bronchodilatortherapy
Disease-based Mechanicalventilation
Not applicable
An even mix of complex and simple protocols.
Medical Staff Order Practices - Manager Survey
Estimate the percent of your medical staff who routinely order respiratory therapy by protocol
0%5%
10%
15%20%25%30%
35%40%45%
0-25 26-50 51-75 76-100 Not applicable
If you add the N/A (meaning they don’t have protocols established for physicians to order) to the 0-25% category, that is the majority of physicians.
Manager Perception of Medical Staff Opinion
0%
5%
10%
15%
20%
25%
30%
35%
40%
Extremelysignificant
Somewhatsignificant
Notsignificant
Staff Physicians
Are opposed
Are concerned that the therapistsdon't have the skills required
Are unaware of the clinical andeconomic benefits
Perceive they would lose control
Many physicians are opposed or perceive they would lose control.
• The medical directors of departments
• The managers of the department
• The nurses
• The administrators
The Manager Survey Indicates the Following are NOT Barriers
Managers Perceive the Barrier as …
• It was apparent from the survey that the medical directors and managers felt that a portion of the barrier was that RT didn’t have the skills to function under protocols
• That perception MUST change…..
Staff Surveys
• Surveys were emailed to all identified as “staff” therapists in the AARC member database with1705 responses
• The following slides represent the perceptions of staff therapist of administration, medical staff, nurses and themselves
Respondents Region - Staff Survey
U.S. Census Region
5%
6%16%
14%
10%23%
6%
10%10%
#1 New England
#2 Middle Atlantic
#3 East North Central
#4 West North Central
#5 South Atlantic
#6 East South Central
#7 West South Central
#8 Mountain
#9 Pacific
Demographics – Staff Survey
Hospital Location
0%
10%
20%
30%
40%
50%
Rural Suburban Urban
Rural
Suburban
Urban
Staffed Bed Size – Staff Survey
0%
5%
10%
15%
20%
25%
30%
35%
40%
Less than 100 101-200 201-400 401 or more
Hospital Type - Staff Survey
0% 20% 40% 60%
Government-Non-Federal (state, county,city-county, community-
owned, etc.)
Non-Government not-for-profit (church affiliated, etc.)
Hospital Type of Ownership
Is this hospital affiliated with a medical school?
0%
10%
20%
30%
40%
50%
60%
70%
Yes No
Same as manager’s survey, the majority are not-for-profit.
Most are not affiliated with a medical school.
Investor Owned for Profit
Government owned
Do You Have Protocols? - Staff Survey
Protocols Established
0% 10% 20% 30% 40% 50% 60% 70% 80%
Yes
No
Although staff reports most departments having protocols, the manager survey shows most do not have a comprehensive protocol system.
Staff Perception of Managers as Barriers
Staff do not view a manager as a significant barrier.
Staff Perceptions of Medical Staff as Barriers
0 100 200 300 400 500 600
Are opposed to care being deliveredby protocol.
Are concerned that the therapists don'thave the skills required to implement
protocols.
Are unaware of the clinical andeconomic benefits of implementing
protocols.
Perceive they would lose control of thetreatment provided to their patients if
protocols were implemented.
1-Not significant
2
3
4
5-Extremely significant
Staff perceive physicians sense a loss of control as a significant barrier.
Staff Perception of Medical Directors as Barriers
0 100 200 300 400 500 600
Is opposed to care being delivered byprotocol.
Is concerned that the therapists don't havethe skills required to implement protocols.
Is unaware of the clinical and economicbenefits of implementing protocols.
Percieves they would lose control of thetreatment provided to their patients if
protocols were implemented.
1-Not significant2345-Extremely significant
Medical directors do not pose a significant barrier to protocols
Staff Perceptions of Nurses as Barriers
0
100
200
300
400
500
600
Is opposed to carebeing delivered by
protocol.
Is concerned that thetherapists don't havethe skills required toimplement protocols.
Is unaware of theclinical and economic
benefits ofimplementing
protocols.
5-Extremely significant
4
3
2
1-Not significant
Nurses are not perceived as a significant barrier for most staff.
Staff Perception of Respiratory Therapist as Barriers
0100200300400500600700800
Are opposed tocare beingdelivered by
protocol.
Don't have theskills required to
implementprotocols.
Are unaware ofthe clinical and
economicbenefits of
implementingprotocols.
Are concernedthat staff wouldbe reduced if
protocols wereimplemented.
5-Extremely significant
4
3
2
1-Not significant
Respiratory therapists do not view themselves as a significant barrier
Willingness to Learn Another Skill if Protocols Reduce the Need for RTs? – Staff Survey
Are you willing to learn other skills?
0%10%20%30%40%50%60%70%80%90%
100%
Yes No
This demonstrates RTs adaptability and should serve the profession well in the future.
Do RTs View Themselves as Barriers? – Staff Survey
Are RTs themselves are barrier?
0% 20% 40% 60% 80%
Yes
No
Therapists do not view themselves as the barrier to protocols
Staff Survey Conclusions
• Medical staff are perceived as the most significant barrier to protocols.
• Most RT staff do not view themselves as significant barriers
• Staff therapists do not view administrators and manager as significant barriers
• Nearly all RTs are willing to learn additional skills if adoption of protocols will assure that patients receive appropriate care
A Note from the AARC Protocol Implementation Committee
• Please use these slides in assessing potential barriers when implementing programs in your facility
• You should assess if the specific barriers at your hospital are different, so you can develop a successful strategy to overcome those barriers
• For additional information visit the Protocol Resources at www.aarc.org
• You can also contact the Chair of the Protocol Implementation Committee for a complete file of the Manager and Staff Surveys
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