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The study by Berg and colleagues1 published in this issue of the Journal reinforces evidence that non-physician–executed protocols are effective in managing some aspects of critical illness.2,-,4 Of particular interest to me was their unexpected finding: “the negative impact of protocols on team communication.” The investigators did not discuss the questionnaire and mentioned it only passingly concerning the need for future study. What strikes me as odd is that respiratory therapists (RTs) having acquired a small degree of autonomy in ventilator management would (of their own accord) noted less frequent communication and collaboration with physicians. In essence, the protocol, allowed a degree of autonomy which resulted in dissatisfaction with a loss of communication.
I think the investigators’ surprise stemmed from their focus on RT “by-in” rather than physician buy-in. This is particularly important given numerous ICU attendings supervising care who rotate in and out on a weekly or biweekly basis. I suspect that the reticence to pursue this issue further is that doing so might reveal discordance within or between academic departments involved in critical care. Understandably, such discussions would be viewed negatively within the institution and might even terminate …
Correspondence: Rich Kallet MSc RRT FAARC, 2070 Fell Street Apt #1, San Francisco, CA. 94117–1878. E-mail: richkallet{at}gmail.com
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