Drema Garrity - Research Statisitcs Powerpoint


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CollettiButkus (5 years ago)

Robin Emerson wrote: Great presentation Drema!! This is a topic that was very interesting to me. I found the research regarding RTs traits to be the most fascinating. Thanks for sharing!!

CollettiButkus (5 years ago)

kelly- You had a very good PICO question! I thought it was interesting and would have never thought of something like that. I found it interesting to learn about it from the studies you found. You did a great job with the powerpoint. I couldn't understand what you were trying to actually say. I'm not sure what happened. But, other than that, it was very good!

CollettiButkus (5 years ago)

Good job Drema, I too think it is important to reduce the patients stay in the hospital. This study shows with a little extra time with respiratory guidance the patient can move forward. Shawn

CollettiButkus (5 years ago)

Alyssa Bekowies-Good presentation! So sorry you had such trouble due to the storm. Enjoy your vacation!

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INTRODUCTION At Springfield Regional Medical Center where I work, we do not utilize respiratory therapist driven protocols to help determine patients who need basic respiratory care treatments such as oxygen, breathing treatments and frequencies, or even IS and PEP therapies. I wanted to discover if the use of protocols improves patient outcomes, so I developed a PICOT question to help with my research.

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PICOT Question Do in-patients who are assessed by therapists using protocols to suggest treatment frequencies receive care that is indicated by AARC standards and have more quality time with therapists who are better utilized than those in hospitals who don’t have therapist driven protocols that are used during inpatient hospital admits?

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Research Studies I searched for research studies in peer reviewed journals to help find the answer to my PICOT question. The reference for the first article is : Harbrecht, B.G., Delgado, E. , Tuttle, R., Cohen-Melamed, M.H., Saul, M.I., & Valenta, C. (July 2009). Improved Outcomes With Routine Respiratory Therapist Evaluation of Non-Intensive-Care-Unit Surgery Patients. Respiratory Care, 54(7), 861-867.

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Hypothesis: The researchers hypothesized that respiratory therapist driven evaluate and treat protocol for non-ICU surgery patients would reduce respiratory complications and improve patient outcomes. Variables: Independent variable – respiratory therapist driven protocols Dependent variable – reduction of respiratory complications and improved patient outcomes

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SAMPLE AND DESIGN The sample size was divided into two groups. One group was studied before protocol initiation and had n = 2,230 patients. The group that was studied post protocol initiation has a n = 2,805 patients. Both patient groups were well matched in age, sex, Charlson score, and admitting service. This was a cohort study where groups of patients were followed for 8 months to determine outcomes such as number of ICU days, costs, etc.

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DATA COLLECTION Data was collected for the same period of time (8 months) pre and post protocol initiation. Data was collected on demographics, admitting service, number and type of treatments, stay, and in-hospital mortality. ICU admissions were cross checked with rapid response records and tracked. Indications were taken from medical records for admission to ICU in a manner blinded by whether a protocol had been used or not. Medical co morbidities were assessed using the Charlson index. The number and type of respiratory treatments were tracked as well as total hospital cost per patient. Patients who were assessed using a standard protocol post initiation were evaluated using a standardized system so that care was uniform.

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RESULTS Data was collected for the same period of time (8 months) pre and post protocol initiation. Data was collected on demographics, admitting service, number and type of treatments, stay, and in-hospital mortality. ICU admissions were cross checked with rapid response records and tracked. Indications were taken from medical records for admission to ICU in a manner blinded by whether a protocol had been used or not. Medical co morbidities were assessed using the Charlson index. The number and type of respiratory treatments were tracked as well as total hospital cost per patient. Patients who were assessed using a standard protocol post initiation were evaluated using a standardized system so that care was uniform.

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ANSWERS The initiation of the protocol did result in a decrease of total hospital stay and costs so the data supported the hypothesis that protocols improve patient outcomes.

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LIMITATIONS AND CONCLUSIONS The limitations were that only a select group of physicians and units were studied for the protocol and the study was not a randomized trial. The researchers suggested a larger study in different areas of the hospital and other hospitals to see if the results would result in different hospital areas. The researchers concluded that the research supported their hypothesis and did in fact improve patient outcomes

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RECOMMENDATIONS The researchers suggested that therapist driven protocols should be implemented and studied in other in patient units in the hospital to see if they also result in a decrease in patient hospital stay and decreased costs and therefore improved outcomes.

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Qualitative Study Full citation: Mishoe, S.C. (2003). Critical Thinking in Respiratory Care Practice: A Qualitative Research Study. Respiratory Care, 48(5), 500-516.

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Research Purpose The purpose of this study was to identify and describe the critical thinking skills and traits of experienced RRTs. Critical thinking was defined as a combination of logical reasoning, problem-solving, and reflection.

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VARIABLES The study asked questions to gather information to help understand the traits needed and the application skills in the hospital setting of RRT’s using critical thinking skills.

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SAMPLING TECHNIQUE The researchers used nonprobability purposeful sampling to select a sample of 18 RRT’s to study. An equal number of men and women were chosen and the participants were recognized experts who met the following sample criteria: earned RRT credential; worked full-time in intensive care units (ICU); had at least 5 years of clinical experience; and earned either an associate or baccalaureate degree. The therapists worked in a southeastern state in 7 different hospitals.

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RESEARCH DESIGN The researcher used an observational study design in which she observed over the course of one year 125 hours of 18 different therapists working in ICU. She also spent 36 hours interviewing the sample with structured open ended questions that she inconspicuously tape recorded.

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DATA COLLECTION The researcher recorded her field notes on standardized forms immediately after observing therapists in the field and after interviewing them. The researcher used methodological triangulation to improve internal reliability and validity of the data in addition to member checks, peer consultation, and audit trail writing.

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RESULTS The data collected consisted of detailed field notes from interview questions and participant observer field notes. The data also included audio tape recordings of interviews. The researcher used the constant-comparative method described by Glaser and Strauss to analyze the material. The text book describes constant comparative on page 140 as the process of coding, categorizing, and analyzing incoming information while seeking to find linkages to data already collected.

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ANSWERS TO RESEARCH QUESTION Through observation and data collection, the researcher identified seven characteristics or skills that are necessary for excellent critical care thinking skills. These characteristics included the ability to prioritize, anticipate problems, troubleshoot technical problems, communicate the therapist’s ideas about a situation, negotiate care with other care givers, make individual and group decisions, and the ability to reflect on how decisions might affect the patient.

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CONCLUSIONS The author noted that qualitative articles are limited by the enormous amount of time spent on data collection and the recording and transcribing of the information collected. She felt she could have collected a larger sample if she had additional team members in addition to herself to broaden the scope of the study. The author felt confident that she had uncovered the seven basic traits necessary for effective critical thinking skills and noted that critical thinking skills are becoming even more important with the advent of more responsibilities being placed on the health care worker. She felt that these skills could be developed in the hospital continuing education programs and respiratory education settings leading to better respiratory therapists. The seven skills she identified were prioritizing, anticipating, troubleshooting, communicating, negotiating, decision making, and reflecting.

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RECOMMENDATIONS The author suggested that since she had identified the seven necessary characteristics needed to facilitate critical thinking skills in respiratory therapists, schools she incorporate methods to help future and current therapists to grow their skills by participating in problem based learning, small group discussion, and case –based approach to learning.

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RESEARCH ARTICLE THREE Full Citation: Stoller, J. (July 2004). The Effectiveness of Respiratory Care Protocols. Respiratory Care, 49(7), The researcher conducted a literature review to see if respiratory care protocols improved the allocation and effectiveness of respiratory care treatments in both the ICU and adult non-ICU in patient care units.

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VARIABLES How respiratory therapy protocols affected the delivery of respiratory services to maintain that treatments are used in cases where they are clinically indicated and patients who need therapy receive it while those who are not indicated and gain no benefit from it do not.

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SAMPLE CRITERIA He did a research review to gather information from many research studies to support his hypothesis.

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RESEARCH DESIGN For the ICU setting, he chose research studies that applied to the use of protocols to manage ABG draws and mechanical ventilation weaning. For the non- ICU review, he chose studies that focused on how protocols affect the cost allocation and utilization of respiratory care practioners.

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DATA COLLECTION He did a literature search to find studies that assessed the allocation of respiratory care services after the initiation of respiratory therapy protocols in different hospital settings.

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ICU SETTING RESULTS He found six studies to support the use of protocols in the ICU setting. They included one study on ABG protocols conducted by Brown et al was a before and after observational cohort study that looked at the number of ABG’s drawn before protocol initiation, 1 month after initiation, and 3 months after initiation. The findings of this study showed that ABG’s were only drawn inappropriately at the bench mark 1 month and 3 month intervals at a rate of 3% and 15% post protocol , and non-protocol samples showed an increased value of 45% and 37%. The results showed that protocols improved allocation of resources and saved patients from unwarranted ABG draws. An observational cohort study by Pilon et al showed the increase in appropriate ABG draws over a 2-13 month period of time from 44% to a 78%-79% average. This study also showed a cost savings per patient of $19.18 per day and a decrease in the total number of ABG draws per patient per day from 4.9 to 2.4-3.1 with a p<0.0001. 3 random controlled studies on adults and one on pediatric patients also presented positive outcomes with patient weaning times after protocol initiation. They all showed shorter duration of patient on mechanical ventilators, a shorter period of time between patients meeting criteria to extubate and actual extubation, and an improved weaning success rate.

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NON-ICU LITERATURE Non- ICU literature showed observational studies on several different therapies such as Oxygen therapy, and bronchial hygiene therapy. The Oxygen titration protocol was utilized in post-surgery patients. The study showed an increase in cost savings and shorter periods of O2 use post-surgery. The other studies presented showed a better following of the AARC guidelines and utilization of therapy more often only when indicated which helped with staff allocation and health care costs.

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ANSWER TO RESEARCH QUESTION The literature review supported the authors hypothesis that Respiratory protocols improved the allocation of respiratory care services in many different areas of the hospital.

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CONCLUSIONS AND RECOMMENDATIONS He suggested that the use of protocols needs to be studied in other areas like extended care facilities, palliative care areas, and geriatric care. He suggested that protocols be used because literature shows that they support better allocation of respiratory services in non ICU areas and quicker weaning to mechanical ventilator patients with less unnecessary ABG draws in ICU patients.

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RESEARCH ARTICLE FOUR FULL CITATION: Shelledy, D., LeGrand, T.S., & Peters, J.I. (August 2004). An Assessment of the Appropriateness of Respiratory Care Delivered at a 450-Bed Acute Care Veterans Affairs Hospital. Respiratory Care, 49(8), 907-916.

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RESEARCH QUESTION The researchers sought to study in a 450 bed VA hospital what percentage of respiratory care was ordered but not indicated, the percentage of respiratory care that was indicated but not provided, and to estimate the labor costs and any savings that might occur with use of respiratory therapist driven protocols.

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VARIABLES Using a respiratory assessment protocol based on recommendations of the AARC and indications for therapy, the researchers hoped to find the percentage of unnecessary treatments that were ordered by physicians vs. the number that were indicated and not ordered, and the total cost savings that is accrued if any from the utilization of protocols.

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SAMPLE Over the course of a 10 week period a sample size of 75 patients were assessed using a protocol that was based on AARC guidelines to recommend therapy. All patients during this period of time receiving basic respiratory care as defined as O2 therapy, nebulizer or mdi treatments with bronchodilators or steroids, incentive spirometry, chest physiotherapy, and IPPB underwent a 4 part protocol assessment. The outcomes were then compared to the actual basic respiratory care prescribed by the doctor.

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RESEARCH DESIGN The study was a comparison study using a purposive sample that compared treatments provided by doctors with those indicated with the use of a respiratory protocol utilized by a group of RRT’s trained in its use.

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DATA COLLECTION The data was collected as part of a quality assurance program. I saw no mention in the article of informed consent or blinding of the data collectors, but basically they were only comparing the treatments ordered by doctors vs. those indicated by protocol. The same group of highly trained, experienced RRT’s did all of the patient assessments which helped to ensure validity.

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RESULTS Of the 75 patients in the sample, 17.7% of those ordered by a doctor on oxygen therapy were not indicated by protocol guidelines to receive it. 32.4% of the bronchodilator therapy ordered was also not indicated as assessed per protocol. 42.9% of those patients ordered on mucolytic therapy were not indicated per protocol. 37.5% of chest physiotherapy was not indicated. On the reverse side, 36% of the patients who were indicated for lung expansion therapy per protocol were not ordered to receive it per doctor order. 8% of patients who were indicated to need O2 were not ordered on it per doctor order. A mean of all categories resulted in a total of 11.8% of patients assessed and indicated for basic respiratory therapy were not prescribed it by doctor order alone.

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RESEARCH QUESTION ANSWER The average mean of results showed that 24.8% or the patients were prescribed respiratory care that was not indicated per protocol and AARC guidelines and 11.8% of patients who needed respiratory care were not ordered on it. The researchers estimated that $75, 395 were wasted in extra labor alone not including equipment and supplies on unnecessary respiratory treatments.

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CONCLUSIONS They concluded that protocols improved patient care and utilization of respiratory resources while decreasing health care costs due to delivery of care not indicated. Limitations of the study were that the patients sometimes were not assessed on the same days as doctor’s assessment which might result in a patient’s condition at the time of assessment being different. Another liability was that inter-rater reliability was not assessed, though the staff was trained on protocol usage.

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RECOMMENDATIONS They thought that the study showed the effectiveness of respiratory care protocols to improve overall outcomes and patient care.

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Summary: Respiratory Therapy Protocols