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AARCII.pptxCreating a Vision for Respiratory Care: Future of Health Care—2015 and Beyond, Part II
AARC Initiative 2015
Summary of future trends in health care enterprise of the US
Primary emphasis will be on changes which will
Improve quality
Decrease cost
Increased emphasis on care of individuals with chronic conditions (e.g. COPD) since frequency of these patients will increase as baby boomers age.
There will be an increased focus on wellness and prevention, since this is more cost-effective than high-tech, episodic, acute care
An increasing proportion of health care will be delivered in lower-cost, non-acute care facilities
Increases in technology will continue to make the cost of episodic, acute care more and more effective, but also more and more expensive
Information technology will continue to play a greater and greater role in the delivery of Health care services
Electronic medical records
Telemedicine
Telecare
Increased convenient access to information (e.g. evidence based medicine)
Patients and families will be able to learn more about their conditions and participate more actively in their own care
The use of protocols will continue to expand
Respiratory care technology will continue to expand
Closed-loop mechanical ventilation
More sophisticated monitoring of patients
More sophisticated diagnostic instruments
Drugs will become more numerous and sophisticated
More delivered by aerosol including drugs for organs other than the lungs
Designer drugs
Gene therapy
Simpler and more efficient extra corporeal gas exchange devices
Summary of future trends in health care enterprise of the US
More and more respiratory care will be delivered outside the hospital arena
LTAC’s
Physician offices
Home
Fee for service clinics and urgent care centers
The respiratory therapist will become more and more involved in research and education
Summary of future trends in health care enterprise of the US
A Vision for the RT of the Future
The second 2015 and Beyond Conference identified the competencies that will be required of a graduating Respiratory Therapist in the future. Seven competency areas were identified:
Diagnostics
Disease management
Evidence-based medicine and respiratory care protocols
Patient assessment
Leadership
Emergency and critical care
Therapeutics
Within each competency area specific competencies were further identified. A total 73 individual competencies were identified
How identified competencies match the future trends in respiratory aspects of health care
Two factors are driving the changes listed above
Demand for cost reduction
Demand for quality improvement
Cost reduction
Strategies for reducing healthcare costs are being implemented throughout the industry
These include
Increasing productivity
Greater emphasis on wellness
One mechanism for making more efficient use of staff is the development of multidisciplinary care teams where a function is carried out by a team rather than someone from just one specialty (e.g. nursing)
One area where this is occurring is in the area of case management and disease management.
RT’s are slowly moving into this area once dominated completely by RN’s
RT’s are beginning to assume leadership roles when cases have a primarily respiratory focus
Development of multidisciplinary Rapid Response Teams in the hospital which always include RT’s as members helps to identify patients at risk for ICU admission and treat before that occurs. Respiratory distress is the number one reason for rapid response calls.
How identified competencies match the future trends in respiratory aspects of health care
Demand for quality improvement
Reduction of medical errors
Certain occurrences have been classified as “sentinel events” which are not reimbursable by the federal government. Private insurance has adopted the same standards
VAP
Skin breakdown
Readmission following discharge within a certain time frame for certain conditions such as COPD exacerbation, CHF, pneumonia. These are among the most common conditions resulting in readmission
Preventing these occurrences has already resulted in cooperative care teams in the ICU in the case of VAP and skin breakdown
This will require development of new models of care, emphasizing follow-up of patients, identifying problems before they require rehospitalization, and modification of therapy once the patient is out in the community (home or skilled nursing center)
The skill set of the RT is uniquely suited to deal with patients with these conditions.
The development of leadership skills will be necessary for RT’s to move into leadership roles in the area of health care.
How identified competencies match the future trends in respiratory aspects of health care
How identified competencies match the future trends in respiratory aspects of health care
Use of protocols
Research has shown that protocols both lower costs and improve patient care
Decrease medical errors
Identify the most appropriate treatment since they are usually based on published evidence
Decrease frequency of unneeded treatment
Result in earlier cessation of treatment
Delivery of respiratory therapy by protocol has been defined by the AARC 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.”
First respiratory protocols were developed in the 1980’s. Today most protocols are for therapy outside of the critical care arena.
The future will see the development of more and more protocols for use in the ICU (e.g. therapist driven ventilatory management protocols).
Therapists should not use protocols but should play a role in their development. This will require a whole new skill set.
The therapist in the critical care environment
Mechanical ventilation is the major competency area in the ICU. The graduate RT must be prepared to enter the ICU as an expert in mechanical ventilation.
Know the appropriate application of various modes of MV (e.g. VC, PC, SIMV-PSV, HFOF, APRV, NIV, etc) and how they are best applied to severe respiratory disease states (e.g. ARDS, trauma, COPD, sepsis, pneumonia, etc)
Know the pathophysiology of disease states and how that impacts on MV
Know various forms of monitoring and how they impact MV (e.g. ventilator wave forms, lab values, hemodynamic parameters)
Know the application of adjuvant modalities such as ECMO, ventricular assist devices
Have a knowledge of pharmacology of drugs used in the ICU for treatment of respiratory patients and their impact on all organ systems
How identified competencies match the future trends in respiratory aspects of health care
The most important tool for the graduate respiratory therapist is Critical Thinking Skills
Seven domains of critical thinking specific to respiratory care have been elucidated through research:
Prioritizing
Anticipating
Troubleshooting
Communicating
Negotiating
Decision making
Reflecting
Critical thinking skills will allow for the graduate respiratory therapist to assimilate new knowledge and skills once he/she reaches the work place and contribute in the most meaningful way at the earliest opportunity.
How identified competencies match the future trends in respiratory aspects of health care
The Evolution of the Future Respiratory Therapist
The knowledge base and skill set of the respiratory therapist will continue to enlarge as health care becomes more and more complex.
Today all educational programs prepare the graduate therapist for the RRT credentialing examination. This credential has been recognized by the AARC, the NBRC, and CoARC as the appropriate credential for all respiratory therapists to achieve.
Licensure of respiratory therapists exists in 49 of the 50 states.
At the present time all states recognize the CRT credential as the minimum required for licensure.
In Ohio beginning on Jan 1, 2015 all new applicants will have to have the RRT credential in order to receive a license.
The development of the 2015 and Beyond document has raised the bar for the graduate respiratory therapist. In doing so it has also raised the bar for the practicing RRT.
The 2015 and Beyond document envisions the evolution of the future respiratory therapist in three major steps:
The Graduate Respiratory Therapist
No credential in hand
Possessing the competencies outlined in the 2015 and Beyond document
Fully prepared to earn the RRT credential
The Practicing Registered Respiratory Therapist
Possessing the skills outlined in the 2015 and Beyond document
Adding to them through additional education and experience in the work place
The Registered Respiratory Therapist Specialist
As the required knowledge base and the scope of practice of the profession of Respiratory Care increase, more and more RRT’s will become RRT Specialists.
More and more specialty credentials are being developed, and this trend is likely to continue. For example Ohio State is presently doing a needs assessment study to determine whether a master’s level Advanced Practice Respiratory Therapist who would have a level of education and responsibility similar to that of a physician assistant or advanced practice nurse is a viable option at this time.
See table below for a partial list of specialist credentials which are either a part of respiratory care or closely related.
The Evolution of the Future Respiratory Therapist
Educating the RT of the FUTURE
Primary Focus of Part III of the “2015 and Beyond” initiative. Results of the third conference were published in Respiratory Care, May 2011, 56(5) 681-690.
Major recommendation and time lines for major policy changes and effective dates for implementation are as follows:
