A few years ago, the OR STAT lab at Covenant Health in Lubbock, TX dissolved and its services were incorporated into the main lab at the hospital. Physicians didn’t love the change, and when they issued a request for the OR STAT lab to be reinstated, it was time for respiratory therapists to take the lead.
“Our blood gas supervisor, who is a cardiopulmonary tech himself, and has been for many years, was asked to help with the re-implementation of the OR STAT lab,” said Dawn Robinson, MBA, RRT, director of respiratory care services. “When asked, ‘how will you staff this lab?’ his suggestion was to bring in respiratory therapists.”
According to Robinson, who now manages the OR STAT lab along with the respiratory care department, RTs were perfect for the job. They were already knowledgeable about hemodynamics, balloon pumps, arterial puncture, and the interpretation of lab results, and their background and training gave them an advantage when it came to the additional training they would need in arterial line (or artline) insertions.
The first therapists trained in the lab were those who had excellent critical care experience. They had also been trained as a part of the department’s Airway Management Team, which was implemented a number of years ago to train RTs to intubate.
“These highly skilled RTs were the first to be allowed to work in our OR STAT lab based on their experience and critical thinking abilities,” Robinson said.
The artline training they received consisted of hands-on sessions with an anesthesiologist and the blood gas supervisor. Each therapist performed a required minimum of 30 supervised artline insertions before performing the procedure on a solo basis.
Long list of responsibilities
RTs have staffed the OR STAT lab for seven years now, and Robinson says their responsibilities include:
- Performing Artline insertions and invasive CVP monitoring
- Assisting with IABP setup
- Assisting with trans-esophageal probe during open heart procedures
- Drawing and running labs in the OR suite: ABG’s, ACT, HepCon
- Assisting the perfusionist
- Transporting and setting up of lines post-surgery in the ICU
- Assisting in PACU as needed for ventilated patients/BiPAP patients/blood gases
- Setting up and assist with floating Swan Ganz catheters with monitoring of SVO2, CO, CI, and PA pressures
- Conducting cerebral oximeter setup and monitoring
Since RTs assist physicians as they set up for procedures or various interventions in the OR suite, a level of teamwork developed that Robinson says “improved our relationships with our physicians and shown them that we are a trusted and valued partner in the care of patients.”
An overall improvement in patient care resulted as well, due to the respiratory therapist’s ability to quickly identify critical values in test results, thus helping the physician immediately identify problems with the patient.
Three pieces of advice
What advice does Dawn Robinson have for other RT managers who would like to expand their services to the OR STAT lab? Here are her top three recommendations —
- Be passionate about what you do, advocate for your teams to everyone. Respiratory therapists add tremendous value to the care of patients due to their education and skills.
- Get physicians on your side; get your staff excited about new opportunities; think outside the box.
- Don’t recreate the wheel; lean on others who have reached these milestones and ask how they went about achieving these opportunities.