Using Tele-ICU to Provide Respiratory Therapy Students Experience With COVID-19 Patients

Abstract

Background: Clinical rotations are essential to respiratory therapy students (RTS) learning objectives. The COVID-19 pandemic profoundly affected RTS education by limiting their bedside exposure, as they were prohibited from caring for COVID-19 patients. Here we describe a clinical rotation at a tele-ICU (eICU) which gave RTS access to COVID-19 patients. Our goal was to increase their knowledge of the disease process to better prepare them for the workforce.

Methods: Students from two universities completed clinical rotations in a tele-ICU as a part of an IRB-approved observational study. They completed two, four-hour rotations with an experienced telemedicine RT preceptor (eRT) in the eICU. Data collection occurred from February 2021 – May 2021. Along with their preceptors, RTS rounded on 320 ICU beds across five hospitals. Primary objectives of the clinical rotation included performing remote patient assessments, interpreting ventilator waveforms, arterial blood gases, and chest x-rays. RTS received education on lung protective ventilation and spontaneous breathing protocols. During ventilator rounds, RTS filled out demographic surveys to identify the complexity and diversity of the patient population.

Results: Thirty-three RTS included in the study rounded on 370 patients during their remote clinical rotations. Of the patients RTS interacted with, 57% (n = 211) identified as male. Mean age of the population was 52.5 ± 18. Racial make-up closely resembled the diversity in the region with 39% (n = 145) Black and 50% (n = 183) white patients. Ninety-two percent of the patients were mechanically ventilated and RTS completed 239 patient-ventilator assessments. The primary disease processes of patients seen were ARDS (n = 178) and COVID-19 (n = 145). In patients with ARDS, 36% (n = 65) required follow-up due to issues related to adherence to protocol. Volume-targeted modes of ventilation were most commonly used, 47% (n = 175). Patient interventions included 73 instances of worsening symptoms on mechanically ventilated patients. Twenty-eight patients were deemed high risk airways which required increased surveillance.

Conclusions: During this remote clinical rotation, RTS had the opportunity to interact with and complete assessments on patients diagnosed with COVID-19. This rotation prepared RTS to care for a diverse patient population via the eICU and increase their knowledge and experience with COVID-19 patients despite a lack of traditional hands-on experience.