healthcare value analysis
By Garry Kauffman , RRT , FAARC , MPA , FACHE
Hygiene and Respiratory Care Services : A Survey of Care During the COVID Pandemic
As a career-long respiratory therapist ( RT ) turned healthcare consultant , I speak with RT leaders daily . The themes that resonate in these conversations are safety and efficacy . RTs think both about patient safety as well as safety for clinicians . Efficacy goes hand in hand with safety , in that it ’ s critically important that respiratory care services are delivered according to the best available evidence . In my experience , delivering services with scientifically validated devices , supplies , and capital equipment provides not only the best outcomes for the patient but does so with the highest degree of safety .
Throughout the pandemic , access to devices was a significant barrier , particularly for those devices manufactured outside of North America . Many respiratory therapy departments were forced to “ use whatever they could get their hands on ,” as one director stated . While access seems to have subsided , respiratory therapy leaders need to reassess the changes they made during the most challenging times to ensure that the devices they are currently using are those that have been validated and not just because they have the lowest acquisition cost . I use this quote from Warren Buffett , who while not an RT , reminds all of us that what we pay up front doesn ’ t reflect value : “ Price is what you pay ; value is what you get .”
The following are individual responses to questions posed to respiratory therapy leaders representing different hospital sizes and types from across the U . S .:
Question 1
What impact did the pandemic have on your respiratory care services regarding hygiene / safety ?
●Policies and procedures were modified in several areas . Interventions that historically were limited to the intensive care unit ( ICU ) were allowed in other areas of the institution . Personal protective equipment ( PPE ) was allocated , mandatory precautions were established , and we established an AGP list to enhance safe practice .
●During the pandemic , use of hand hygiene , and the appropriate PPE , became an even greater focus not only for safety , but initially for fear of survival .
●Created an early and acute focus on personal protection and availability of PPE , in addition to an active awareness of our interventions that may increase risk .
●The pandemic touched nearly every aspect of our operations , as keeping a safe and healthy workforce is essential to sustaining our patient care capabilities . There were lengthy isolation and quarantine periods that affected staffing , particularly in the early waves while COVID testing was in its infancy . Looking back , ability to staff safely was probably the most substantial concern , and in addition we ’ ve had to deal with ongoing losses and vacancies as the pandemic has continued .
●PPE supplies were limited early on which was a concern to achieve the workforce protection goal , as were items we use
where demand soared such as filters for various new applications .
●There were not enough rooms with doors and negative pressure rooms especially early on , and higher oxygen and respiratory support needs affected where a patient could be placed .
●While we were struggling with necessary practice modifications for hygiene and safety , there was the ever-present risk from anyone unmasked who coughed and could generate a far higher expiratory flow with dispersion risk . Since one doesn ’ t always know who is infectious and can be an asymptomatic carrier , it is like the advent of universal precautions earlier in my career for bloodborne pathogens . With respiratory pathogens , getting patients and visitors to also wear masks was something new in the hospital to try to mitigate this risk .
●Infection control , hygiene , and safety are always a paramount when providing respiratory care . The pandemic served as a reminder to staff and helped solidify our practices . Due to the pandemic the department was compelled to be more proactive increasing access to PPE prior to the therapist reporting to their assigned patient care area . Prior to the pandemic , therapists would have just obtained PPE in the patient care areas .
●We certainly found ourselves becoming the bedside experts on enhanced airborne precautions and aerosol-generating procedures . Often before non-respiratory therapy staff would check the plethora of available resources , they would ask an RT . When half-face respirators came into the market , RTs were seeking to learn more about them and asking if they would become part of our PPE arsenal . They were quick to adopt this new PPE option and asked questions regarding filtration of exhaled particles , etc .
Question 2
Which procedures / services did you modify because of the pandemic ?
●We had to balance between optimizing patient outcomes and maintaining staff safety .
●We modified almost every service we delivered . Services where there as a potential risk for production of fugitive aerosols were eliminated or conducted under the strictest of protocols . These procedures / services included but were not limited to , bronchoscopies , tracheostomies , sputum inductions , intubation process during codes , aerosol medication delivery , noninvasive ventilation , heated high flow nasal cannula use , open suction , and intubations in the ICU and emergency room .
●When inhalers were in short supply , we developed an interdisciplinary plan with pharmacy , nursing , and infection prevention and control colleagues to temporarily implement a common cannister protocol not previously utilized .
●From an outpatient standpoint , we began to utilize telemedicine technology and home monitoring with our cystic fibrosis patients . We initiated weekly telemedicine calls with these patients to track daily CPT and medication therapy . Through these efforts , therapy compliance increased , and we