.jpg "Fajun Wang, MD, photo")
Megan Lowman, MSN, RN, TCRN
MSN, RN, TCRN
UPMC Mercy, United States
Disclosure information not submitted.
Samantha Zych, MSN, RN, CEN, CMSRN
MSN, RN, CEN, CMSRN
UPMC Mercy, United States
Disclosure information not submitted.
Jonathan Bishop, MD, MBA, FCCP
Director of ICU service
UPMC Mercy, United States
Disclosure information not submitted.
Firas Abdulmajeed, MB. ChB
Assistant Professor
University of Pittsburgh UPMC Mercy, United States
Disclosure information not submitted.
Title: Impact of Respiratory Therapists-Driven Protocol on Unplanned Adult Neurovascular ICU Readmissions
Introduction
The purpose of this prospective quality improvement initiative was to reduce unplanned respiratory-related ICU readmissions among adult neurovascular patients with a respiratory therapists-driven assess-and-treat (RTDAT) protocol. Our primary goal is to decrease the respiratory-related rapid-response alerts and to reduce respiratory-related ICU readmissions.
Methods
We retrospectively reviewed 655 adult neurovascular patients who required ICU readmissions between January 2019 and September 2019 as the historical control group. The RTDAT protocol was initiated with a standardized patient assessment tool, which was completed by registered respiratory therapists on duty. This tool developed a respiratory severity score for each patient and directed interventions on bronchial hygiene, aerosol therapy, lung hyperinflation therapy, and adjusted treatment frequencies according to the set-forth algorithm. The RTDAT protocol was implemented from July 20th, 2020 to January 20th, 2021, and enrolled 263 patients. Data related to rapid response alerts and unplanned ICU readmissions of adult neurovascular patients were collected and analyzed.
Results
94 out of 655 screened subjects had 135 rapid responses called on them in the historical control group. Their age (66.96 ± 15.20 years) was significantly younger than the RTDAT group (75.06 ± 14.58 years) (P < 0.001). The NIH stroke scale in both groups was not statistically different (10.15 vs. 12.63, P=0.41). Patients in the RTDAT group had fewer rapid responses alert (13.69% vs. 14.35%) and respiratory-related readmissions (39.13% vs. 58.70%); however, these results did not meet statistical significance. RTDAT group spent 1 day less in the ICU (P < 0.001) and 4 days less in the hospital (P < 0.001).
Conclusions
RTDAT protocol implementation demonstrated a decrease in rapid response alerts and respiratory-related ICU readmissions; however, they did not reach statistical significance due to insufficient sample size. Nevertheless, RTDAT protocol did improve the length of ICU stay and hospitalization significantly.