Abstract
Background: Respiratory therapy (RT) staffing is driven by the American Association for Respiratory Care’s Safe and Effective Staffing Guide (SESG). Our pediatric hospital (244 beds, Level 1 Trauma Center, Level IV NICU) utilized time standards (WLUs) driven by the SESG for respiratory care services collected manually twice per day to determine strategic staffing for operations (Figure 1). Manual calculation of RT WLUs can be time consuming and has risk for human error. We aim to assess the impact of transition from manual calculation of WLUs to automated electronic medical record (EMR) calculation on respiratory therapy non-clinical time and missing order rate.
Methods: A team of RT leaders met with EMR analysts to design a report driven from RT orders and RT tasks that associated each service with WLUs to determine how many RTs were needed per shift per area. The team met weekly for 3 months and began by validating WLUs per ordered RT service and validating calculations and reports (Figure 2). In an IRB approved retrospective review, missing orders and non-clinical time savings were evaluated 60 days before and after implementation of the EMR automated report on 3/1/2023. The analyst team met with RT leaders weekly after implementation to review discrepancies between manual count and the automated EMR report.
Results: On average the RT department staffs 16 RTs per day in 10 units, inclusive of 1 charge therapist (TIC). On average, RTs utilized 14 min (staff RTs) and 44 min (TIC) for manual WLU calculation (254 min (about 4 hours)/shift). The EMR report of time standards took an average of 4 min to run, and the TIC utilized 29 min on average to format data and adjust staffing for the next shift. Staff RTs do not review WLUs in the automated process. Incidence of no orders for RT services decreased from 78 pre EMR report to 67 post report. 17 discrepancies were found during report validation and all but one was able to be resolved (combination therapy). The manual count and automated report were within 5% accuracy prior to going live.
Conclusions: Transition from a manual WLU report for RT staffing to a manual report from the EMR saves 450 min (about 7 and a half hours) per day in RT non-clinical time. Additionally, the number of RTs order errors decreased 14% in the study period. This change allowed more time at the bedside for RTs without impact on strategic daily staff management. Further research must be done to support combination treatments in automated EMR reports.
Figure 1 details the manual process of WLU calculations.
Figure 2 shows the EMR report for WLUs in the electronic form.
Footnotes
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