The respiratory care staff at Paoli Hospital is charged with serving both the respiratory care and pulmonary diagnostic departments.

In only 3 years, Paoli Hospital, a member of The Main Line Health System, has metamorphosed from a medium-sized suburban community hospital—the “little hospital up on the hill”—to a level two trauma center serving Philadelphia’s Chester County. The transformation drastically increased the workload facing the respiratory therapists at Paoli, but they have more than risen to the challenge and now focus on better improving patient care and outcomes.

Paoli—one of only 50 hospitals in the nation to take part in the Pebble Project, a joint research effort with The Center for Health Care Design to apply evidence-based “best practices” to the design of health care facilities—opened a new 500,000-square-foot patient care pavilion in 2009, almost doubling the size of the hospital, and increasing the number of licensed beds from 157 to 214. The expansion required Karen Kofalt, MS, RRT, director of respiratory care, pulmonary diagnostics, and cardiac rehabilitation, to grow the respiratory care department to meet the new needs, bringing the number of full-time equivalent (FTE) respiratory therapists to 15, or approximately 23 employees.

This staff serves both the respiratory care and pulmonary diagnostic departments, yet they don’t work in a vacuum. Patients receive care from an integrated team of registered respiratory therapists, registered nurses, and physicians. This team approach, and a close relationship with the nursing staff in particular, allows the respiratory care department to focus its efforts on critical care patients in the intensive care unit and emergency department. The nursing staff in turn does much of the respiratory floor care, with the respiratory care staff serving as consultants available to do reevaluations as needed.

“The relationship with nursing is very strong and I think extremely essential to the respiratory staff providing the quality care they need to at the bedside,” says Kofalt.

This integrated approach allows the respiratory therapists to also staff the hospital’s state-of-the-art pulmonary diagnostic department, featuring a diagnostic lab, pulmonary rehabilitation program, and maintenance program. The department— the third in the country to have its outpatient chronic obstructive pulmonary disease (COPD) program certified by the Joint Commission Disease Certification—identifies patients with lung issues who are then referred to the rehab program by a physician. The 12-week program provides patients with twice weekly education and exercise training sessions. Once they graduate, rehab patients are encouraged to join the department’s self-pay maintenance program. Unlike a local gym, the maintenance program provides patients with supervision and monitoring, including blood pressure and blood saturation, and also allows them to work out with others like themselves. Three respiratory therapists and five exercise physiologists staff the pulmonary diagnostic department, and as Kofalt says, “They do an amazing job. They are the brains behind the success of our COPD disease certification.”

The same skill and dedication that went into creating a successful COPD program found its way into the staff’s efforts to reduce patient ventilator days and cases of ventilator associated pneumonia (VAP). Paoli averages about 1,800 ventilator days annually and has an “extremely low” VAP rate, according to Kofalt—a trend the department strives to maintain. “Obviously, decreasing infection between patients and preventing VAP are extremely important to us as we move toward the era of value based purchasing where hospitals won’t necessarily get reimbursed for hospital acquired infections. So we strive to maintain a safe environment for our patients and staff. Our focus and education supports our commitment to preventing hospital acquired infections,” she says.

Another department priority has been to decrease noninvasive ventilation and the number of patients intubated and put on ventilators. The use of high flow nasal cannulas is instrumental in this effort.

“We’re using a lot of high flow nasal cannulas and we’re noticing that our noninvasive days are really decreasing. It’s also preventing patients from being transferred to a higher level of care,” says Kofalt. “Right now, we’re in the process of formulating a few case studies to show to our doctors how successful we are with this tool. It’s something that we’re very excited about, and it’s going very well.”

The success of Paoli’s respiratory care staff is clear. It has thrived amidst rapid growth, and all the while maintained a commitment to quality patient care and improved patient outcomes. As Kofalt says, “I’m extremely proud of the care we give and the staff’s commitment to patient outcomes.”

255 W Lancaster Ave
Paoli, PA 19301

Alison Werner is associate editor for RT. For further information, contact .