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