HSC’s respiratory care services are continually focused on quality improvement.

By Pamela Held, RRT, MEd,
and Connie Dills, RRT, RPFT, MBA

Hospital for Special Care was one of RT Magazine's Best of 2013

Hospital for Special Care (HSC) is a 228-bed, long-term acute care facility located in central Connecticut with a satellite serving the Greater Hartford area. HSC provides a continuum of highly individualized, compassionate care from pediatrics to adulthood and is nationally renowned for treatment in the areas of pulmonary disease, acquired brain injury, complex pediatrics, neuromuscular disorders, spinal cord injury and disease, cardiac conditions, and autism. Recently, The Hartford Courant and FOX-CT recognized HSC as a “Top Workplace” in Connecticut, coming in at number 3 in the state.

Our 95 respiratory therapists (RTs) at HSC care for an average of 100 ventilator-dependent patients in addition to a large number of pediatric and adult patients with other complex medical needs. These treatment areas range from pediatrics, ventilator weaning, pulmonary rehabilitation, and neuromuscular and asthma clinics, to long-term ventilator management. Our patients are often with us for weeks and months, and in some cases years, which means RTs work closely with physicians, nurses, pastoral care staff, physical therapy, occupational therapy, therapeutic recreation, speech therapy, nutrition, and social work to ensure the best quality of life.

Our department is always focused on improving the level of care we provide. In early 2013, we created a team composed primarily of staff-level therapists to perform a quality improvement process. Our goal was to improve delivery of care and RT job satisfaction, and create an efficient and cost-effective environment for sustainable, high-quality respiratory care services. A driving force of the process was to move from a unit-based model to a more centralized one. This allows RTs to maintain their skills across a range of patient care, to serve as resources for each other, and also reduces compassion fatigue associated with caregiving.

As a result, a number of successful respiratory care initiatives were implemented. Some of the more significant initiatives included a ventilator-weaning protocol for adults and pediatrics, bronchodilator protocols for adults and pediatrics, assessment and therapy protocol for non-mechanically ventilated patients, and several more.

The final challenge was to establish a more efficient staffing model that allows for a better allocation of resources. Our leadership structure was relatively unchanged; it includes a director of respiratory care services (an RRT), who oversees the RT supervisors and our clinical educator. Resource and support RTs provide unit-specific oversight in the absence of a covering supervisor and/or educator.

The process allows us to improve cost savings and billing accuracy, while enhancing interdisciplinary communication. The accomplishments of the quality improvement team and our entire staff have advanced innovation in our department and have created a progressive, forward-thinking atmosphere. Our success has been recognized by senior administration and board members and has helped respiratory care services to become a model for other departments, which face similar quality improvement challenges.

RTs are active in professional associations and community-based activities, including the leadership boards of the American Lung Association and Connecticut Society for Respiratory Care, Connecticut Pulmonary Section board, as well as community walks and other events. Our department also supports students in four Hartford-area respiratory therapy schools in both clinical and didactic settings, and some go on to become HSC RTs following graduation. This process is mutually beneficial and ensures RTs will play an integral role in the longevity of the profession.

Looking ahead, our department will continue to develop protocols to better serve our patients and community through the establishment of management programs for conditions like COPD, congestive heart failure, and pediatric asthma. Through these initiatives, Respiratory Care Services at Hospital for Special Care will meet the needs of the ever-changing healthcare environment and continue to be a place where RTs may thrive in their profession and make a lasting difference in the health of our patients. RT

Hospital for Special Care
2150 Corbin Ave
New Britain, CT
(860) 223-2761