Resp Care
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Chronic obstructive pulmonary disease (COPD) is the second greatest cause of disability in the USA. COPD rehabilitation programs can reduce numbers of rehospitalizations, reduce overall costs of care, and improve the quality of patients' lives. ⋯ Respiratory therapists can participate in pulmonary rehabilitation programs in program design and evaluation, in interviewing, educating, and counseling patients and families, by performing respiratory and physical therapy, and in vital research on costs and benefits of pulmonary rehabilitation. In addition, some respiratory therapy managers may direct financial management of such programs.
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The difficulty of delivering respiratory therapy according to currently accepted standards is an important problem in many hospitals. As a result of this problem in our hospital, we developed a new therapy delivery system--the Respiratory Care Protocol. ⋯ The Respiratory Care Protocol has been well-accepted by patients, physicians, and respiratory therapists, and by Joint Commission on Accreditation of Hospitals evaluation teams. We believe that our use of the Respiratory Care Protocol has led to improved quality and to the reduced cost of our in-hospital respiratory care.
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Endotracheal intubation in emergency situations is a recognized function of respiratory therapists, as defined by the American Association for Respiratory Therapy in 1973. A training program based in the operating room, using one-on-one instruction, was the basis for a training program designed to meet JCAH standards for endotracheal intubation. To evaluate the success of our training and our system for attempting intubations, we recorded the results of 50 consecutive intubation attempts by our therapists. ⋯ While 39 patients were intubated within one minute, 11 required more than one minute. In five patients, physicians had attempted intubation prior to a therapist's arrival; those intubations took eleven times longer than those that were attempted by therapists only. The average time for intubations attempted solely by therapists was 54 seconds.
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We designed and implemented a program to train respiratory therapy personnel to perform emergency endotracheal intubation in a community hospital. During a one-year study period, 143 emergency intubations were attempted by physicians, nurse anesthetists, and respiratory therapy personnel. ⋯ Physicians and nurse anesthetists attempted 69 intubations, with 39 complications, for a complication rate of 57%. We conclude that trained respiratory care personnel can safely and effectively secure an airway via endotracheal intubation under emergency circumstances in our institution.