By Debbie Bunch
October 1, 2024
Every year, the AARC honors the best and brightest in the profession during an annual Awards Ceremony at the AARC Congress. The event culminates with presenting the Association’s highest honor—the Jimmy A. Young Medal, awarded to an individual who has exceeded all expectations for meritorious service to the profession and patients it serves.
The 2024 honor will go to a man who has moved mountains to help patients who have long been underserved by the medical community. He has engaged respiratory therapists in the effort every step of the way.
Russell A. Acevedo, MD, FAARC, FCCP, FCCM, created the Lung Partners Program at Crouse Hospital in Syracuse, NY, more than 20 years ago at a time when RTs and their physician colleagues had few resources to stop the revolving door of hospital admissions seen for those with COPD.
From Math to Medicine
Dr. Acevedo, who currently serves as a health care consultant, an intensivist at Crouse Hospital, and a clinical professor of medicine at Upstate Medical University, credits his interest in medicine to his early affinity for numbers.
“My first true love was mathematics,” he said. “In college, I soon learned that physical chemistry was mostly applied mathematics. In medical school, I discovered that physiology is predominately math and physical chemistry.”
Dr. Acevedo received his undergraduate degree in biochemistry and genetics from Cornell University and his MD from the University of Rochester. When he began his residency in internal medicine at Upstate Medical University, he was delighted to find that critical care and respiratory care are also mainly applied physiology.
He first became involved with RTs during his critical care fellowship at the University of Pittsburgh. “The associate director of the training program was a respiratory therapist, and the respiratory therapist in the ICUs taught the fellows the science of respiratory care,” he recalled, noting that at the time, he thought that was how things were done everywhere.
“Foolish me, thinking this was the standard,” he quips now. However, that early and highly positive introduction to the profession set Dr. Acevedo on a path that would continue to involve RTs. The highlight of that partnership came in about 2010 when, as the then-medical director of the RT department at Crouse, he conceived of a new program that would pair RTs with hospitalized patients in an effort to provide them with the care and tools they would need to remain healthy and out of the hospital.
Necessity is the Mother of Invention
Like many successful ventures, the effort had its roots in a challenging situation for his hospital at the time.
“Crouse Hospital was in bankruptcy due to billing issues, not market share,” he explained. “In fact, we were the busiest hospital in Syracuse, but we weren’t paid. Due to the bankruptcy, our RT department was understaffed and couldn’t recruit successfully.”
Because they were short-staffed, RTs needed help delivering all the liquid inhaled medications that were being prescribed.
Dr. Acevedo decided it was time to get creative. “We fundamentally changed how we delivered aerosols by using longer-duration, short-acting bronchodilators and faster breath-activated nebulizers,” he said. We successfully achieved the clinical effect quickly and maintained it with only three treatments per day.”
He says their protocols for using high-efficiency nebulizers and longer-acting medications enabled them to get the time efficiencies of an MDI with liquid nebulization. “We wanted the land speed record for liquid nebulization,” he said.
Lung Partners is Born
Thanks to the time saved by the new aerosol policy, therapists eventually had free time, and Dr. Acevedo decided the best way to use that free time was to establish the Lung Partners Program, which has since become his legacy.
The program revolves around a partnership between an RT and an individual COPD patient. “The primary therapist is linked with the COPD patient for life, including the index admission and all subsequent readmissions,” explained Dr. Acevedo. “This allows the primary therapist to learn the barriers to keeping their patient at home.”
The primary RT delivers medications and screens for anxiety, depression, mobility problems, and other disease management issues. They also provide patient education and assess the patient’s use of their devices. Since hospitalists at Crouse do not screen patients for COPD-related comorbidities, the primary therapists take on that responsibility as well.
They also participate in the discharge planning process and address any issues their patients may have once they do go home.
One-to-one relationship is key
Dr. Acevedo believes RTs are perfect for the role. “The respiratory therapist is the most appropriately trained and skilled clinician to be a physician extender for COPD management,” he said.
Dr. Acevedo said the key to the long-term success of the program, which is still in operation today with 27 specially trained primary respiratory therapists serving more than 600 COPD patients, is the one-to-one nature of the relationship.
“The COPD patient has someone they can talk to, and the RT has the time to listen to their issues,” he emphasized. “Lung Partners has a direct hotline that the patient can call in with problems, and our RTs will help them. The personal touch is key.”
Dr. Acevedo says the program’s outcomes demonstrate its value to both patients and the organization. “Some of our outcomes include a reduction in COPD readmissions by 24%, reduction in late treatments by 90%, and significant cost reductions, among others,” he said.
A full report on the program can be found in the April 2023 edition of CHEST.
Onward and Upward
Their success with the aerosol delivery changes, notably Lung Partners, led Dr. Acevedo and his RT department to embark on a constant journey to improve processes and share their efforts with their colleagues through presentations and publications.
“Our mantra was: The only constant is change. Our standard was to have at least one performance improvement project presented at OPEN FORUM or CHEST each year,” he said. “Most years, we presented multiple projects.”
Indeed, more than 20 at last count, many co-authored by RTs. Dr. Acevedo notes that the department was also an early adopter of therapist-driven protocols, noninvasive positive pressure ventilation, the common canister, and high-flow nasal oxygen.
“Every new protocol we implemented, we collected data on the performance and reported our results,” he said.
Work in the Broader Stage
Dr. Acevedo has also been an active supporter of the respiratory care profession on the wider stage, serving in multiple capacities in both the AARC and the New York State Society for Respiratory Care (NYSSRC).
He has been a long-time member of the AARC’s Board of Medical Advisors (BOMA) and has served as medical director and program director for the NYSSRC’s annual education symposium.
Dr. Acevedo is also a champion for the profession among his medical colleagues, something he emphasizes is vital to moving the profession forward.
“I believe respiratory therapists are vastly underutilized in clinical practice. We try to have our RTs practice at the fullest extent of their licensure,” he said. “This should be the norm, but the profession is far off from that. To grow the RT profession, there needs to be significant physician support.”
He has worked toward that goal through his service as the liaison between CHEST and BOMA. He is particularly interested in ensuring that medical directors of respiratory care are appropriately educated for the job.
“We do not train our pulmonary fellows adequately in the science of respiratory care,” he said. “It is hard to have a fully functioning and engaged medical director of RT departments if they don’t understand the discipline.”
Dr. Acevedo also supports a baccalaureate degree entry for RTs while acknowledging the vital role played by associate’s degree programs, a premise he advocates for through his work as medical director of the American College of Respiratory Therapy Education (ACRTE).
“I believe that the solution to this goal involves utilizing both the associate and baccalaureate level schools,” he explained. “ACRTE now has member institutions from both levels and is well positioned to move toward creating a hybrid model for bachelor entry.”
As a member of BOMA, he facilitates communication between ACRTE and the AARC, NBRC, CoARC, and other national organizations that support the respiratory care profession.
Dr. Acevedo is an Honorary Member of the AARC and a Fellow of the American Association for Respiratory Care.
Shocked and Humbled
When Dr. Russell Acevedo takes the stage to accept the Jimmy A. Young Medal in Orlando in November, he says he will be honored to be considered among the long list of outstanding men and women who have gone before him as Jimmy A. Young medalists.
“Anne and I were traveling in Norway when the call came. Unfortunately, it was in the middle of the night there. I wasn’t fully awake. I remember learning I was receiving an award, not the award,” he recalled. “It wasn’t until a few days later, when I was receiving congratulations on the award, that I realized it was the Jimmy Young award. I was shocked and humbled.”
The Jimmy A. Young Medal recognizes individuals who have an outstanding record of contributions to the AARC vision of professional excellence, advancement of the science and practice of respiratory care, and service as an advocate for patients, their families, the public, the profession, and the respiratory therapist that are well above the usual commitment of time, efforts, or material goods. It is the highest honor bestowed by the AARC and is named in honor of AARC President Jimmy A. Young, who died in 1975 after serving the organization for many years.
Group pic: Dr. Acevedo with his Lung Partners team back at the beginning of the program in about 2010.
Russ Hall 2: Russ Acevedo in the halls of Crouse Hospital.
Avocado: Dr. Acevedo says the most common mispronunciation of his last name is “avocado.”
RussPhantom: Getting a walk-on part during The Phantom of the Opera on Broadway to celebrate his 50th birthday was another highlight of Dr. Acevedo’s life.
Russ Young: Dr. Acevedo with legendary surfer Nat Young, winner of the World Surfing contest in 1967, at the 50th anniversary of the World Surfing Championship in Rincon, PR, in 2018.
