The following summary was authored by Dianne Johnson, RRT – Project Coordinator and forms part of the
HealthForceOntario’s Optimizing Use of Health Provider Competency Fund
Optimizing Respiratory Therapy Services: A Continuum of Care from Hospital to Home
- June 2008 CRTO applied for and received a HealthForceOntario grant
- To facilitate the timely transfer of LTV patients or those requiring airway management from acute care setting to community
- To improve patients quality of life
- Reduce LOS
- Avoid hospital readmissions
- Official project partners included the CCAC, Professional Respiratory , RTSO and West Park Health Care Centre
- Unofficial partners included London Health Sciences Hospital, McMaster Children’s Hospital, Sick Kids and Ottawa Rehabilitation Centre
- The program was implemented in Ontario utilizing a collaborative, RT led approach to discharging long-term ventilated patients directly from hospital into the community
- The project aimed to develop a model of RT support in the community for ventilator assisted individuals of all ages (both invasive and non invasive) and for individuals requiring tracheostomy care.
- With the assistance of our partners, Training Tools were developed for Respiratory Therapists and Caregivers to assure consistency in the delivery of “best practice” protocols. A total of 15 adult and 6 paediatric tools were developed to be used in both the acute care and community settings for patient identification, patient/ caregiver education and troubleshooting.
The care model developed strengthens capacity in home and community care producing improved client outcomes through collaboration with care partners.
- Many RTs within the critical care team would benefit from a consistent and informative process and resources to assist a patient who is at-risk or is on long-term ventilation.
- Many ICU beds are being occupied by ventilator-assisted individuals who are otherwise medically stable and do not need the critical care services
- Once these individuals are in the community there is little RT support. Why…
- The community RT role is not funded
- Limited community RT support is supplied by the hospitals and volunteerism
Optimizing the role of RTs in long-term ventilation will improve:
- Patient’s and caregiver quality of life and satisfaction
- Health resource utilisation
- The flow of care through the healthcare system
- RT satisfaction
- Ventilator assisted individuals – both invasively and non-invasively ventilated
- Individuals at-risk of long-term ventilation
- Individuals requiring tracheostomy care
1. Providing RT support for this population in the community, including:
- Ongoing education to the client and caregivers
- Initial education to new caregivers
- Ongoing and routine clinical support (24 hours)
- Being a communication resource between the client (community) and the physician (hospital)
2. Providing acute care hospitals with the tools for:
- Patient identification – of ventilator-assisted individuals who are able to go to
- the community
- Timely action – what steps to take, when
- Communication resources – who to consult on the process, equipment etc.
- Initial education – skills that can be taught to the patient and caregivers in the acute care hospital before discharge All interventions provided use a collaborative approach with programs currently discharging long-term ventilated patients into the community.
Progress to date:
- Twenty one patients enrolled , 14 invasive, 7 non invasive -three awaiting discharge
- Ages 1 through seniors
- Ontario wide
- Developed Educational Tools now ready for expert content reviewers
- Developed a communication bridge between hospital staff and RT Home C
- Meeting with hospital teams including CCAC and other community reps helped to outline the project, solidify the role of the community RT and identify challenges
- Awaiting a final report template from HFO
- All stakeholders included in the decision making process
- Worked closely with partners and experts in the field including the VEP
- Applied QOL and satisfaction surveys to 18 patients and caregivers to date