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
  • Goals:
    • 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.
 
Rationale
  • 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
 
Hypothesis
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
 
PROJECT SPECIFICS
 
Population
  • Ventilator assisted individuals – both invasively and non-invasively ventilated
  • Individuals at-risk of long-term ventilation
  • Individuals requiring tracheostomy care
 
Interventions
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