Solid Staffing

At the University of Michigan Medical Center, RTs have successfully shown administrators that adequate staffing in their departments means not only better care, but also lower bottom lines because of reduced lengths of stay.

 Mary Dekeon, RRT, says collegiality contributes to the unit’s success

Even in today’s climate of health care cost cutting, the respiratory therapy department at the University of Michigan Health System at Ann Arbor has bucked the bare-bones trend and has struck a balance between a high level of clinical care and cost efficiency that is music to administrators’ ears. “We’ve been able to effectively show that adequately staffing the respiratory department can help reduce time on mechanical ventilation, which subsequently helps reduce length of stay,” says Ken Bandy, RRT, administrative manager, respiratory therapy at the University of Michigan CS Mott Children’s Hospital. “We’ve worked hard on being able to really gather our supported data and show that maintaining appropriate staffing levels has a positive impact, not just clinically, but financially as well.”

The department’s respiratory therapists are spread throughout the 500-bed medical center, offering care to both adults and pediatric patients.

The adult care is offered throughout the hospital on all of its general floors and in its seven adult intensive care units (ICUs); 65 therapists are assigned to the adult service, responsible for overseeing about 40 ventilated patients per shift.

The 42-member pediatric therapy team provides service to the medical center’s three pediatric ICUs. Patients range from newborns to adults with congenital respiratory conditions. The average stay is 4 days, although some of the young patients can spend several months in the unit.

Although the respiratory therapists are sited all over the medical center, they have a strong esprit de corps that crosses departmental lines, says Mary Dekeon, RRT, senior allied health technical specialist in Maternal Child Health Center-Respiratory Care. “I think that is one of the things that makes our department so extraordinary,” she says. “It’s a total team approach. If therapists are assigned to a unit for a day or a 2- or 3-day stretch, they are essentially there for the entire day. They are as much a part of the team as the nurses are. There is a lot of collegiality between respiratory, nursing, and physicians.”

 From left, Carl Haas II, MLS, RRT, FAARC; Ron Dechert, DRPH, RRT; Kathleen Barnum, RRT; Mary Dekeon, RRT; and Ken Bandy, RRT.

The team approach includes the patients. “In the old days you just gave care—the emphasis was on what you were going to do, not what the patients should know about themselves and their disease,” says Mark Konkle, MPA, RRT, manager, clinical department, Respiratory/ Cardiovascular Services at the University of Michigan Hospital. “We’re trying to move the pendulum to the other side.”

The fact that the respiratory service has become a key part of the medical menu can be attributed to the department’s professionalism, says Bandy. “What makes us stand out is the high level and attitude of our respiratory therapists and technicians, and the respect we get from other services that elevates our feeling of professionalism, which then makes us hold ourselves to a higher level of accountability,” he says. “Getting the respect of physicians and other clinicians has helped us press forward to win financial arguments with administration.”

Respiratory care does not end once patients leave the confines of the University of Michigan Medical Center. In the mid 1990s, the medical center formed a home medical equipment division, which allowed patients on ventilators and other respiratory devices, such as CPAP machines, to be where they and their caregivers wanted them most—home. Currently, the program cares for about 70 ventilated patients—many of them children—and hundreds of other respiratory patients.

Once a month, therapists check on their ventilated patients—who have a caregiver or family member helping them—and are available round the clock. In addition to improving patients’ and caregivers’ stress level by getting patients into familiar surroundings, there are added health benefits. “It gets them out of the hospital, where there are more germs,” says Kathy Barnum, RRT, senior allied health technical specialist with the University of Michigan Health System Medical Equipment Operating. “People just thrive in their own home environment.” Four to 6 weeks after a ventilated patient is sent home, the weaning process begins.

Research and Education
With its ties to the University of Michigan, the department also has a strong research and education focus. It is involved in several research trials, including five associated with the National Institutes of Health’s Adult Respiratory Distress Syndrome (ARDS) network. “From a respiratory therapy standpoint, they’re an adjunct to the study,” says Ron Dechert, DRPH, RRT, manager clinical department II, respiratory therapy at the University of Michigan CS Mott Children’s Hospital, who also coordinates, manages, and serves as an investigator for many of the projects. “They have to understand the protocols and then comply with the ventilation strategies defined by those protocols.”

Recently, educational activities have become more formalized with the implementation of an adult, in-house asthma program. “We try to give patients the tools to empower them to take better control of their own disease,” says Carl Haas II, MLS, RRT, FAARC, senior allied health technical specialist, respiratory care at the University of Michigan Hospital. “Quite a few studies have suggested that when you give the patients these tools, the number of hospitalizations are reduced, the duration is reduced, and they’re better able to manage their asthma.”

“Every day is a challenge in health care,” Bandy says. “I think all of health care is going to continue to experience a shortage of people coming into the profession. Knowing that, how are we going to develop mechanisms to recruit and train our own people, improve our own efficiencies to where we can eliminate unnecessary tasks, improve our productivity?” Bandy is looking at the new technological frontiers and how his respiratory therapists can take part in the initial research phases to be a part of the future and continue being an integral part of the University of Michigan Medical Center.

C.A. Wolski is associate editor of RT.