As the healthcare system evolves, it is imperative that facilities streamline care of diseases such as COPD and ensure continuity, from the ICU all the way to the home environment.
RTs & Care Plans
Although respiratory therapists have historically been on-hand in the inpatient environment and are able to address and successfully manage most pulmonary issues such as COPD, Brian Carlin, MD, FAARC, assistant professor of Medicine, Drexel University School of Medicine, suggests an upsetting of the status quo.
In his presentation "COPD Disease Management--a Model for All Settings" from the 2013 American Association for Respiratory Care (AARC) Congress, he took aim at the notion that respiratory care should be limited to the inpatient or ICU setting.
"In the inpatient arena, most respiratory therapists are involved in the ICU and acute care," he said. "I think the really important thing is having the respiratory therapists get involved in the transition when the patient is getting ready to go home or go to a skilled nursing facility. I think that's a very key thing and although more are getting involved with that, I still think it's a minority of them overall."
Teamwork & Coordination
In terms of achieving the best possible outcomes for patients with COPD, Carlin advocated for the application of a new multidisciplinary approach, which aids in the transition of the individual from the inpatient arena to the step down or rehab facility, and then finally to the home.
Respiratory therapists have been traditionally underused during this transition, according to Carlin. He cited an example of a program in Pittsburgh where the RTs go into a home to evaluate the environment for any potential impediments to the resumption of a healthy daily routine.
"A couple of the programs, at least in the Pittsburgh area, that have been used in transitioning of care involve a respiratory therapist going into the home, helping the patient with their oxygen and really centering the care around that individual patient - helping with oxygen, activities of daily living, medication and showing the person how to use their inhaler the right way," Carlin explained.
"Another type of program is where the therapist actually starts working with the patient in the hospital and then follows that patient once they go home," he continued. "When the patient comes back to the office or the hospital for their outpatient visits, the therapist is involved in the care there as well."
This program's focus goes beyond the introduction of oxygen and its correct use and actually takes into consideration all aspects of daily living. It is "enabling the respiratory therapists to center care around the individual patient," Carlin said.
"Most respiratory therapists are trained and have experience in the inpatient arena and have very limited training or experience in the outpatient," Carlin continued. "They need to sort of be retrained as to what to look for in the home environment, which I think is the most important environment."
While Carlin conceded that this sort of comprehensive approach obviously varies state-to-state per regulations and resources, he still advances the notion that the RT really needs to "coach" the transition. The advantage of nationally standardized protocols for this care would be the achievement of optimally efficient results.
"You have to use the different resources that you have available to create the most effective program you can, but it varies wildly across the country," Carlin stated. "Everything is fairly localized."
Continuity of Care
Carlin also made the point that a continuity of care for patients with COPD is effective and desirable.
In his view, "medicine cannot be put in silos anymore. That's the direction medicine is going, you have to work as part a team. You can't have it where someone says 'I'm going to prescribe the medicines' and then nothing else is going to happen for six months after seeing them. That's not the right way of doing things."
Carlin also noted that with the further implementation of the Affordable Care Act, penalties will begin to be assessed against hospitals and practitioners when patients with COPD return to be treated multiple times.
"We've been talking about these transition programs for five, six, seven years, and now it's going to be important," he admitted. "When the government says you can potentially be penalized if too many people are coming back to the hospital after they've been discharged, when that starts to occur then people are going to scramble to put these teams together and it takes time."
"You can't do this overnight; there's a lot of education and planning that needs to go together to get these teams working well," he concluded. "That's why football teams practice eight months out of the year and then play games the other four."
Carlin's model is one that is presently used in other therapeutic disciplines and one that could revolutionize respiratory care in the United States across all settings.
Tamer Abouras is on staff at ADVANCE.