Improving Physician Therapist Collaboration Paul L. Goldiner M.D.,D.D.S Medical Director,...

Improving Physician Therapist Collaboration

Paul L. Goldiner M.D.,D.D.SMedical Director, Respiratory Therapy

BMCC Emeritus Professor, Anesthesiology

Mt. Sinai School of Medicine

Qualities M.D.’s Value in a Respiratory Therapist

• Compassion• Communication• Critical Thinking• Detail Orientation

Attributes

• Communication• Participation• Professionalism

Communication

• Speak the M.D.’s Language

• Steps to achieve this begins in school.

Participation

• Clinical• Economic• Research

Economic Engagement

• Service-hospital committees, etc.• Employee engagement -outcome evaluation-risk management-productivity evaluation

Research Participation

• Respiratory Care: 2004, June; 42 (6) 600-5• Results of a Physician and Respiratory

Therapist Collaborative Effort to Improve Long Term Metered-Dose Inhaler Technique in a Pediatric Asthma Clinique.

Professionalism

• Therapist driven protocols are the gold standard in M.D.-Therapist collaboration.

How They Would Work

• Therapy adjusted more frequently to changes in patient’s status.

• M.D.’s contacted for major changes, not minor adjustments.

-eliminates nuisance calls• Consistency of therapy is maintained.-non-pulmonary M.D.’s assure proper care by

requesting protocol therapy.

Protocols

• RCP’s actively involved in achieving good outcomes.

-rather than performing rote tasks• Raises the level of the profession.

Advantage of Protocols

• Avoids misallocation of respiratory care• Improves the quality of care• Cuts costs

• Without Protocols, multiple studies have identified the problem which includes:

-poorly ordered oxygen therapy, incentive- spirometry, bronchodilator therapy, ABG’s, etc.

Today

• Inappropriate care is unacceptable in the current health care environment

• When the protocols are used = improved care

Protocol Based Respiratory Care Reduced Inappropriate Care By:

• 61% bronchial hygiene (Shapiro et al.)• 59% aerosol medications (Zibrak et al.)• 92% IPPB (Zibrak et al.)• 55% Incentive Spirometry (Zibrak et al.)• 72% ABG’s in ICU (Browning et al.)• 48% basic care (Hart et al.)

Study Published in Chest by the ACCP

• Evaluation of the effectiveness of respiratory therapy driven protocols

-694 consecutive patients-safe-greater agreement with institutional treatment

plans than with MD directed care-overall rate of discordant respiratory care orders

were significantly less than MD directed care

• Respiratory Therapy Driven Protocols Enhance Professionalism.

• Characteristics of Successful Respiratory Therapists

-from Advance, September 2012 By Jimmy Thacker

• Be a Competitor• Be Smart• Be a Turtle• Have Ideas• Use Your Instincts• Be a Leader• Be Special• Be Confident• Have a Head for Business• Schmooze on a PRN Basis