Chapter 2

Quality and Evidence-Based Respiratory Care

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Learning Objectives

Describe the elements that constitute quality respiratory care.

Explain methods used for monitoring the quality of respiratory care provided.

Explain how respiratory care protocols enhance the quality of respiratory care services.

Define disease management. Describe evidence-based medicine.

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Elements of a Respiratory Care Department

Medical Director Responsible for clinical function of department Usually is pulmonologist or anesthesiologist Must possess both management & clinical skills

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Elements of a Respiratory Care Department (cont.)

Medical Director (cont.)

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Responsibilities of the medical director of Respiratory Care include all of the following except:

A.educating the medical and nursing staff regarding respiratory therapy

B.participating in the preparation of the department budget

C.organizing the weekly work schedule

D.participating in respiratory care in-services and training programs

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Elements of a Respiratory Care Department (cont.)

Respiratory Therapists Quality of RT department depends on education,

experience, & professionalism of therapists RTs are primary source of quality care provided by

department

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Credentialing in Respiratory Care

Quality RC departments are staffed with RTs who hold appropriate credentials

To be eligible for credentialing, individuals must graduate from CoARC-approved educational programs

Graduates can then sit for certification & registry exams offered by National Board for Respiratory Care (NBRC)

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Professionalism

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Technical Direction

Quality respiratory care depends on strong leadership

Manager of department usually provides technical direction This person oversees policies, procedures, &

equipment used to provide safe & effective patient care

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Methods to Enhance Quality Respiratory Care

Respiratory Care Protocols Put in place to enhance appropriate allocation of

respiratory care services Represent guidelines to deliver care only when

indicated, by correct method; discontinued when no longer needed

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Respiratory Care Protocols

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Respiratory Care Protocols

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Respiratory Care Protocols

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Respiratory Care Protocols (cont.)

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According to respiratory care protocols, what is the minimum frequency for assessing patients for a change in clinical status?

A.Every other day

B.Every 4 hours

C.Once per shift

D.Once a day

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Standardized Assessment

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Care Plan

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Monitoring Quality Respiratory Care

After all elements are in place, quality respiratory care is maintained by monitoring

One method to monitor quality of care provided : seek voluntary accreditation

Accreditation by The Joint Commission is most important

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Monitoring Quality Respiratory Care (cont.)

Current Joint Commission standards call for continuous quality improvement (CQI)

CQI is an ongoing process to detect & correct factors hindering quality care

AARC has developed 4 goals that should be included in CQI plan

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Monitoring Quality Respiratory Care (cont.)

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Monitoring Quality Respiratory Care (cont.)

Competencies or “checks”: used to test skills & knowledge through use of clinical simulations

Used mainly for procedures that carry degree of patient risk Examples: arterial puncture, aerosol therapy,

BiPAP set up, intubation, & ventilator management Simulated patient scenarios help determine

consistency among RTs

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Skill Checklist

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Monitoring Quality Respiratory Care (cont.)

Peer Review Organizations Federal government established elaborate system

of PROs to evaluate quality of care given to Medicare beneficiaries

Such PROs evaluate care provided to individuals in real time to ensure compliance with federal guidelines

Accountable Care Organizations (ACOs): emerging groups of health care providers

ACO’s work to enhance quality of care, receive payments, & lower costs

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Care Plan Audit

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Hospital Restructuring & Redesign

An attempt to do more patient care w/ less overhead

Common approaches include: Cross-training employees Using unlicensed assistive staff Decentralizing services (patient-focused care)

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Disease Management

Refers to organized strategy of delivering care to large group of individuals w/ chronic disease to improve outcomes & reduce costs

Disease management programs may be developed for patients with asthma, diabetes, chronic obstructive pulmonary disease (COPD), or congestive heart failure (CHF)

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All of the following are the goals of disease management ,except:

A.Reduce costs

B.Develop new strategies

C.Keep track of medication usage

D.Improve outcome of individuals with chronic diseases.

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Evidence-Based Medicine

Represents important concept regarding quality respiratory care

Refers to determining optimal clinical management based on evidence found in scientific literature

Scientific literature publishes best scientific evidence available

Best scientific evidence includes rigorous clinical trials to support most appropriate & correct clinical decisions

Clinical Practice Guidelines (CPGs) developed by AARC represent recommendations based on expert review of evidence

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The goal of evidence - based medicine is to:

A.use results from research for clinical practice

B.use literature based research only for new medications

C.develop new treatments from a single case report

D.disregard older case studies and only focus on more current ones

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Evidence Based Medicine (cont.)

Evidence comes from 4 different types of studies:1. Single case studies ( simplest, least rigorous)

2. Case series (collection of patients with similar clinical features)

3. Cohort studies (comparing 2 groups, greater scientific rigor)

4. Randomized controlled trials (ideal, most rigorous evidence)

Through these studies, new treatments, medications, & new modes of ventilation have been designed

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Evidence Based Medicine (cont.)

For study to be successful, key outcomes are: Survival Discharge from ICU Organ system failures

Meta-Analysis is additional tool of evidence- based medicine: Identifies, analyzes, & summarizes body of

literature for specific topic being studied

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Evidence Based Medicine (cont.)

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What type of study holds the most scientific rigor?

A.single patient studies

B.cohort studies

C.case series

D.randomized controlled trials

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