Transcript Improving Physician Therapist Collaboration

Improving Physician Therapist
Collaboration
Paul L. Goldiner M.D.,D.D.S
Medical Director, Respiratory
Therapy
BMCC
Emeritus Professor, Anesthesiology
Mt. Sinai School of Medicine
Qualities M.D.’s Value in a Respiratory
Therapist
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Compassion
Communication
Critical Thinking
Detail Orientation
Attributes
• Communication
• Participation
• Professionalism
Communication
• Speak the M.D.’s Language
• Steps to achieve this begins in school.
Participation
• Clinical
• Economic
• Research
Economic Engagement
• Service
-hospital committees, etc.
• Employee engagement
-outcome evaluation
-risk management
-productivity evaluation
Research Participation
• Respiratory Care: 2004, June; 42 (6) 600-5
• Results of a Physician and Respiratory
Therapist Collaborative Effort to Improve Long
Term Metered-Dose Inhaler Technique in a
Pediatric Asthma Clinique.
Professionalism
• Therapist driven protocols are the gold
standard in M.D.-Therapist collaboration.
How They Would Work
• Therapy adjusted more frequently to changes
in patient’s status.
• M.D.’s contacted for major changes, not minor
adjustments.
-eliminates nuisance calls
• Consistency of therapy is maintained.
-non-pulmonary M.D.’s assure proper care by
requesting protocol therapy.
Protocols
• RCP’s actively involved in achieving good
outcomes.
-rather than performing rote tasks
• Raises the level of the profession.
Advantage of Protocols
• Avoids misallocation of respiratory care
• Improves the quality of care
• Cuts costs
• Without Protocols, multiple studies have
identified the problem which includes:
-poorly ordered oxygen therapy, incentivespirometry, bronchodilator therapy, ABG’s,
etc.
Today
• Inappropriate care is unacceptable in the
current health care environment
• When the protocols are used = improved care
Protocol Based Respiratory Care
Reduced Inappropriate Care By:
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61% bronchial hygiene (Shapiro et al.)
59% aerosol medications (Zibrak et al.)
92% IPPB (Zibrak et al.)
55% Incentive Spirometry (Zibrak et al.)
72% ABG’s in ICU (Browning et al.)
48% basic care (Hart et al.)
Study Published in Chest by the ACCP
• Evaluation of the effectiveness of respiratory
therapy driven protocols
-694 consecutive patients
-safe
-greater agreement with institutional treatment
plans than with MD directed care
-overall rate of discordant respiratory care
orders were significantly less than MD
directed care
• Respiratory Therapy Driven Protocols Enhance
Professionalism.
• Characteristics of Successful Respiratory
Therapists
-from Advance, September 2012
By Jimmy Thacker
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Be a Competitor
Be Smart
Be a Turtle
Have Ideas
Use Your Instincts
Be a Leader
Be Special
Be Confident
Have a Head for Business
Schmooze on a PRN Basis