Implementing an Effective Respiratory Therapist Within a Hospital Based eICU

Abstract

Background: The University of Kentucky implemented an eICU to work with all ICUs in early/mid 2020. This eICU group consisted of a team of seasoned RNs and an attending MD. In early 2023, the eICU team reached out to respiratory leadership about adding a RT to the eICU team to field respiratory-related calls. Department leadership identified this as a way to increase efficiency and offload work from our bedside staff.

Methods: First, we established a clear set of departmental goals for a RT at the eICU. These included closing safety and quality gaps in patient care, and being an ‘easy button’ for bedside RTs, freeing them up to do more hands-on patient care. Potential barriers to success were identified as well; with staff buy-in being first on the list. To address this concern, existing staff members would fill the new role, utilizing their existing work relationships and knowledge of day-to-day operations. Eleven workflows were identified and rewritten to include an eRT. These workflows were documentation heavy, including intubations/extubations, codes, and other procedures. New items were added to the workflows, including order and charge audits. RT supervisors trained with eICU RNs, prior to a 2-week pilot in June 2023. In week 1, supervisors provided 24/7 coverage and trained staff RTs to rotate through the eICU. During week 2, eRTs covered eICU. After the pilot, a survey was conducted. This feedback identified 3 unsuccessful workflows out of 11, which were removed or refined.

Results: During the pilot period, eRTs fielded over 210 calls. The pilot was extended indefinitely. Surveys found that 40% of RTs called 1-4 times, and 36% called 5 or more times, excluding eRTs reaching out to bedside staff. 66% of bedside RTs rated the helpfulness of the eRT at a 3 or higher on a scale of 5. Workflows involving intubation/extubation, order placement, charges, and charting during busy times freed up the most time. Between June 2023 and March 2024, the eRT has fielded over 4,800 calls, and has expanded to help leadership monitor the mental health of staff, by identifying potentially upsetting events.

Conclusions: Transitioning hands-off tasks to the eRT increased the amount of time bedside RTs had for hands-on care. Using our existing RT staff and their relationships with their peers to staff the eICU increased trust and transparency, and therefore buy-in. Safety was increased through better regulatory compliance and having a second set of eyes for procedures and key points of care.