2/18/14
Lung Expansion & Airway Clearance The Easiest Path Past The Fork In The Road Michael J HewiB, RRT-­‐NPS, RCP, FAARC, FCCM Chair, Respiratory SecGon Society of CriGcal Care Medicine Remember This? The Light Needs To Come On •  Change Our Mindset from ReacGve To ProacGve •  Why Do We have To Wait UnGl They Get “Sick” To Get Busy? •  All ICU PaGents Need To Receive Lung Expansion/
SecreGon Clearance Therapy From Admission To Discharge Via Protocol •  “At Risk” PaGents On The Floors Need To Receive Lung Expansion/SecreGon Clearance Therapy Via Protocol 1
2/18/14
Changing TradiGon Surgical PaGents: Aggressive & ProacGve (90% Of All Surgical PaGents Get Atelectasis) Medicine PaGents: Aggressive & More EffecGve (COPD Goes On The 30 Day Readmission PenalGes List in 230 Days) Is This COPD Readmissions Penalty Thing A Big Deal? A Different Real Life Hospital: COPD Readmission Rates For 2012: 21%* *24% is the magical cutoff rate for audiGng What Do We Need To Know About All This? •  What Is The Actual Number Of PaGents That 21% Accounts For? •  What Number Of These PaGents Are Medicare, Medicaid or Non Resourced? •  What Was The Average Cost Of The Original Admissions? •  What Is The Average Cost Of These Readmissions? •  What Is The Average LOS Of These Readmissions? 2
2/18/14
Another Real Life Example A Hospital In Georgia COPD PaGents ReadmiBed <30 Days in 2013: 350 Average Cost Per Readmission: $35,000 That = $12,250,000 That = Financial Disaster Where Does Your Hospital Lie? So, Now What? We Develop A Plan/Strategy To Decrease These Readmissions: •  BeBer And More EffecGve Therapies •  EducaGon By RT’s (Case Manager CredenGaled?) •  Provide PaGents With BeBer Home Devices •  Post Discharge Home Visits By RT’s For First 30 Days •  Hard Core Data Gathering The Goal? Decrease In Those COPD <30 Day Readmissions Show A DECREASE In Financial Loss Our InsGtuGons Suffer Huge Value Added By Our RT Department A Path Past The Fork In The Road, Taking Us To The Allied Health Professional Level (vs. Ancillary Service) •  The Increased Self Esteem and Confidence Realized In This Dual PaGent/InsGtuGon Success Story •  The Then Natural Want To Find Other Ways To Elevate Our Department And Our Profession •
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2/18/14
OpportuniGes For Success Redefine Oxygen Therapy TransiGoning From “The Chase” Go From This: To This: PosiGve Pressure & Vibratory Therapy 4
2/18/14
High Efficiency Nebulizers Monaghan AeroEclipseTM Aerogen AeroNebTM AddiGonal OpportuniGes The Role Of RT’s In Organ Procurement An Opportunity Just WaiGng For Us 5
2/18/14
When To Use What: •  We Need To Have Organized Approaches To Lung Expansion and SecreGon Clearance •  Lots of Choices •  Requires Total Commitment On The Part Of The Physicians, The RT Staff And Our Nursing Partners •  How Best To Make The Right Choices? Protocols , Algorithms, and Smarts •  Have Well Thought Out Protocols & Algorithms In Place This Is Our Past & Our Present It Will Not Be The Mainstay Of Our Future 6
2/18/14
Is Any Of This Easy? Of Course Not: This Is Hard Work It Is Supposed To Be Hard Work If It Wasn’t Hard Work, Anyone Could Do It The QuesGon Is: Are We Going To Step Up, Strap It On And Take Us To Where We Should Have Always Been? Worth RepeaGng: The Most Expensive Words In Medicine: “But That’s The Way We’ve Always Done It” QuesGons? Michael J HewiB, RRT-­‐NPS, RCP, FAARC, FCCM gatorrrt@yahoo.com 7