Summer 2014 Respiratory Care Management Bulletin
Roger L. Berg, PhD, DSc, RRT-NPS
American Career College
Bill D. Cohagen, MSHCA, RRT, FAARC
Cancer Treatment Centers of America/Western
Phoenix, AZ 85029
Douglas S. Laher, MBA, BSRT, RRT
Notes from the Chair: The Summer Forum of a Lifetime
Bill Cohagen, MSHCA, RRT, FAARC
After 2½ days at the 2014 Summer Forum in Marco Island, FL, all I can say is “wow!” What a great program! What a great venue!
If you weren’t able to attend this year’s Forum you missed quite possibly one of the best openings in years. RT-turned-attorney Tony DeWitt assembled a cast and put our profession on trial in the face of the Affordable Care Act. It was an eye-opening and thought-provoking session, and I can only hope they repeat it at AARC Congress 2014 this December in Las Vegas.
My special thanks go out to Garry Kauffman (my conference committee liaison and friend) and Cheryl Hoer (our incoming section chair) for helping me listen to you, our section members, as we developed programs for one of the best Summer Forums I have been to in a long time.
We had not one, but two excellent and insightful afternoon workshops. The first featured representatives from HealthLinx, an executive recruiter, who filled us in on what the C-Suite is looking for in candidates and how to make ourselves more marketable and useful to our organizations.
We spent the second afternoon with representatives from Huron Consulting, who taught us that consulting firms are not the enemy; if we join with them and help them we can better position our teams for success by adding value to our organizations.
We were also able to add to our leadership tool boxes thanks to lectures from Shawna Strickland on how to provide education to our teams even when we do not have departmental educators or a budget. John Sabo shared a navigator program that will enhance any department faced with decreasing COPD readmissions. Garry Kauffman amazed us with strategies we can use to not only see where our stress lies, but learn how to rate it and help eradicate it.
Steve Nelson shared some tools for us to use from the AARC, while Shawna Strickland gave us great insight on the power of volunteering and having our staff get involved as well. Tony DeWitt reminded us of the “7 Deadly Sins of Management” and how we can avoid them. Finally, we heard a new, up and coming speaker, Judy Schloss, tell us how to create a stellar preceptor team that will help us lead our teams to new levels.
Oh, and I did a little something on managing your own destiny as well.
Overall it was a great 2½ days of learning and networking. I really enjoyed the time I got to spend with my old friends, and I made some new ones as well.
If you were fortunate enough to be at this year’s Forum, I thank you for your time and professionalism. If you were not able to attend, I encourage you to register now for AARC Congress 2014 in Las Vegas, Dec. 9-12.
I cannot wait to see what next year’s Summer Forum in Phoenix, AZ, has in store!
Advanced Resuscitation Training: Cost Reduction CPR Individualized for the Inpatient Setting
Trista Kallis, BS, RRT, Respiratory Care Supervisor
UC San Diego Health System, La Jolla, CA,
and Daniel David, MD, Director
UCSD Center for Resuscitation Science
Editor’s Note: Due to his interest in resuscitative science, Dr. Daniel Davis was contacted by the Resuscitation Outcomes Consortium to assist in creating a novel approach to CPR training. In the following article, he and AARC member Trista Kallis outline the rationale behind the new program.
A new approach to CPR training aimed at improving outcomes in the hospital setting, decreasing cost to the institution, and allowing for continuous quality improvement (CQI) is proving its worth at the University of California, San Diego (UC San Diego). Initial data collected in 2005-2006 showed that respiratory arrest-related deaths were the highest of all arrest-related deaths per 1000 discharges — double their closest counterpart, sepsis. This information appeared to fall in line with the challenge of improving pre-, intra-, and post-care to improve outcomes for patients who arrest in the hospital setting. Creating and implementing a program to accomplish all of these objectives within the UC San Diego Health System, VA Hospital, and San Diego County EMS agencies was the initial goal of the project.
The Advanced Resuscitation Training (ART) program
The ART program is a resuscitation management program for hospitals, clinics, and EMS agencies. ART has the ability to teach specific skills for the inpatient setting as well as out-of-hospital environments. Inpatient ART focuses on a variety of resuscitation issues, from surveillance and monitoring of all patients through critical care, cardiopulmonary arrest, and post-arrest care. Out-of-hospital ART includes cardiopulmonary arrest, prevention of arrest, advanced procedures such as airway management, and sophisticated monitoring strategies. The ART program teaches resuscitative efforts for adult, pediatric, medical/surgical, and trauma patients. End-of-life issues are addressed as well. ART is adaptive and is able to address the dynamic changes that happen within each institution through flexible, integrated CQI data.
Resuscitation performance is strongly linked to patient outcomes. ART integrates a broad scope of resuscitation under a single, unified curriculum, which enhances provider understanding of key concepts, and ultimately, clinical performance.
The ART program aids in creating a culture of resuscitation that serves to improve patient safety. Unlike the existing model of life support training, the ART program recognizes the complexity of patient deterioration and incorporates arrest prevention strategies. The ART program employs an original “Integrated Critical Care Model” with multiple components of resuscitation science that define a new paradigm for inpatient and pre-hospital medicine. The ART program consists of the following core philosophies:
- A simplified, institution-specific approach to resuscitation with the understanding that inpatient resuscitation efforts have specific equipment and capabilities available to them.
- Integration of a broad spectrum of resuscitation concepts, from monitoring/surveillance and arrest prevention though critical care, arrest, post-resuscitative care, and end-of-life issues.
- The use of CQI data to modify treatment algorithms and training, and guide new initiatives.
- A comprehensive approach to critical care education that relates three basic physiological processes (perfusion, oxygenation, and ventilation).
- A flexible, adaptive curriculum that responds to the unique needs of trainees based on provider-type and specific patient characteristics.
- Adult learning principles, including the use of expert physicians, code RN instructors, and RT instructors.
The spread of ART worldwide
The three main components aimed at facilitating broad implementation of the ART program include: 1) ART University; 2) a mentorship team, and 3) information technology resources to facilitate ART implementation/maintenance, training, and CQI.
- ART University employs a center-of-excellence model. Teams from various hospitals implementing ART will attend a week long workshop with the following objectives: 1) to understand the ART program and all of its components, 2) to review the science behind the various treatment algorithms, 3) to understand the principles behind the CQI Matrix, 4) to review the various options for training, 5) to gain exposure to the various information technology support tools and training resources available through the ART program, and 6) to receive specific guidance on implementation strategies.
- A specific mentorship team will be assigned to each institution to provide guidance, maintain suggested timelines, and review progress. This is the critical bridge between purchasing the ART philosophy and full implementation of the program.
- Information technology resources are being developed to address a variety of needs. The database will serve as a portal into the ART Matrix, with guidance software to help classify events and automatic pop-ups for the additional data fields. The Matrix will generate graphical displays and dashboards to facilitate interpretation of CQI data.
- A unique feature of ART education is the i-ART program, which represents a cutting-edge approach to critical care education and assessment. The i-ART program utilizes the i-Human platform, which is a web-based self-tutorial for medical school education that employs interactive education strategies and a complex human physiological model to simulate a variety of disease states.
The new health care reform is forcing hospitals to change the way they view programs and budgets. Many hospitals are trying to cut respiratory departments in order to save money; a better idea is to look at integrated ways to cut costs without disseminating this very important specialty to other departments, as we all know RTs do their job best.
There are a few ways that we are able to show cost saving with the ART program. The actual cost of ART training is 30% less than traditional resuscitation training due to the reductions in overhead and the ability to integrate multiple existing training requirements. The evolution of Value Based Purchasing and the need to address pay-for-performance metrics has resulted in an increasing percentage of hospital revenues at risk. Current estimates place the revenue-at-risk at about $2 million for a moderate-sized institution. The ART program addresses risk-adjusted mortality and a range of other metrics. UC San Diego’s stellar performance on these measures suggests that the integrative nature of ART may be one of its primary benefits.
Avoiding unexpected deaths is also critical to risk reduction. UC San Diego experienced a 95% reduction in medico-legal payments following ART implementation. This performance led to a grant from the UC liability carrier to implement the ART program throughout the UC Medical System. The National Institutes of Health and Agency for Healthcare Research and Quality estimate the cost of an unexpected death to be $30,000-$50,000. The ART program targets unanticipated deaths, with a four-fold reduction documented by both UC San Diego and the VA San Diego. At UC San Diego, this translates to approximately 75 prevented deaths annually, with a projected savings of $2-$4 million.
Since the implementation of the ART program at UC San Diego Health System, respiratory arrest that once showed to be double its closest arrest competitor has become the third cause of arrest, going from 1.75-2.5 per 1000 discharges to .25 per 1000 discharges. Overall in the hospital, we have decreased cardiac arrest incidence by more than 50% and more than doubled survival for remaining victims. This has resulted in a decrease in arrest-related deaths by more than 75% and a reduction in overall hospital mortality by 20%. The training obtained through the ART program is top notch — world-class training that can help save lives, and therefore cut costs, for institutions across the country.
The AACVPR Outpatient Pulmonary Rehabilitation Registry: A Management Tool for Outcomes
Arianna Villa, BS, RRT
Editor, AARC Continuing Care/Rehabilitation Section Bulletin
Pulmonary rehabilitation is an under-utilized service despite undeniable evidence of its efficacy in improving patient outcomes, including physical function and quality of life. Patient outcome collection is essential to continuing to demonstrate the importance of pulmonary rehabilitation and to learn more about how to improve program structure and content.
Although all pulmonary rehabilitation professionals might agree on the importance of outcome collection, actually collecting the data and analyzing it proves challenging for programs across the country. Programs are commonly not staffed with personnel with skills in data collection, entry, and analysis, and thus find it challenging to consistently collect and monitor patient outcome data.
The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) has created the “AACVPR Outpatient Pulmonary Rehabilitation Registry” to track and analyze clinical, behavioral, and health outcomes of patients in pulmonary rehabilitation programs across the country. The Registry also aims to monitor adverse events, hospital admissions/readmissions, and mortality rates in PR patients. The Registry hopes not only to compile data to support PR as the standard of care for patients with pulmonary disease, but also to provide PR programs with data that can be used for program improvement.
The Registry includes:
- Demographic information
- PR program information (i.e., session attendance)
- Medical history information
- Pre/post clinical assessment information
- Functional capacity measures
- Dyspnea measures
- Health-related quality of life measures
- Depression/psychosocial measures
- Oxygen usage
- Health care utilization
PR programs can join the Registry online by agreeing to the participation agreement and paying an annual subscription fee based on program size. Patient outcome information can be entered through the online interface by a variety of methods. After entry, data is saved to the Registry and programs will be able to view the analyzed data formatted into a variety of reports.
For more information on the Registry, visit this page on the AACVPR website. You can also learn more by reading this PDF file.
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