Star Trek is an American cult classic science fiction television series created by Gene Roddenberry that follows the adventures of the starship USS Enterprise and its crew. Iconic Captain James T. Kirk, played by William Shatner, offered the following voiced-over introduction during each episode's opening credits stating the starship's purpose: "Space: the final frontier. These are the voyages of the starship Enterprise. Its 5-year mission: to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no man has gone before."

The AARC recently published 2015 and Beyond: Three conferences that defined the respiratory therapist.¹ Truly, the AARC vision will allow the respiratory therapy profession to boldly go where no man (or respiratory therapist) has gone before. Here are the mission critical questions the AARC answered:

• What will the future healthcare system look like?
• What will the roles and responsibilities of respiratory therapists be in the future system?
• What competencies will be required for RTs to succeed in the future?
• How do we transition the profession from where it is today to where we need to be in the future?

Similar to the adventures of Captain Kirk, and crew boldly going the places where no man has gone before, respiratory therapists (RTs) have the same opportunity in our professional lives. Respiratory therapy is 63 years young as a profession and as already proven to be innovative and flexible.

Why RTs are well positioned to boldly go where no man has gone before?

• Diseases we treat: the top 15 causes of death in 2011 include No. 1 -- heart disease, No. 3 -- chronic lower respiratory diseases, No. 8 -- influenza and pneumonia, and No. 15, pneumonitis due to solids and liquids.² RTs care for four of the top 15 on a daily basis.
• Patient points of entry: RTs work in many of the patient points of entry into the healthcare system -- acute care, emergency departments, PFT labs, bronchoscopy labs, pulmonary physician offices, cardiac catheter and EP labs, sleep labs, home care and pulmonary rehab.
• Patient Engagement: Patient engagement is the area we must improve. Engaging patients and their families with disease education, home environment and resource assessment, care planning, and lifestyle changes is essential. Despite the often high acuity of inpatient admission, the reality is they will spend more time in the hospital. This process must start on admission with teach back to ensure understanding.
• New payment model: Inpatient payment is not service-specific, but rather related to the entire organization. RT is well positioned because of the 911 emergency skills providing service to every area of the hospital and working with every discipline. RTs understand the team approach and working in any environment.

The AARC sites a Price Waterhouse Coopers study published in 2005, which contained the consensus opinions of 580 hospital executives, physician groups, payers, governments, medical supply companies and employers from 27 countries.³ These key points were identified to creating a sustainable future.

• Consumerism: Several professionals have little direct patient care contact and are seldom if ever involved in assisting patients or their families with healthcare choices. This is not true for the RT, who should be able to meet the changing demands of the consumer.
• Application: RTs treat every age population in acute and chronic settings. RTs have the opportunity to educate on pulmonary disorders, sleep diseases, childhood disease, use of artificial airways, ventilators, MDI, HHN and more.
• Wellness and Prevention: A few professions focus primarily on treating the specific malady presented and currently have little training or ability to function in the role of wellness and disease prevention. This is not true for the RT. Current RT education does provide such training; however, future RT education will need to address this concern in greater scope and depth.
• Application: RTs are successful using tobacco settlement funds to say their salaries so they can use evidence-based program to teach nonsmoking as part of cardiac and pulmonary disease prevention in middle schools. Pulmonary rehab programs have demonstrated ability to optimize COPD patients, reducing readmissions. Asthma education with certified asthma educators demonstrates better outcomes.
• Pay for Performance: Though all professionals contribute to the expense of healthcare, some have little ability to modify their work patterns to provide good patient outcomes while improving efficiency. Clearly the provision of respiratory care affects patient outcomes, which has increasingly become a focus of respiratory care practice Future RT education will need to focus more on avoiding iatrogenic injury and on improving patient outcomes.
• Application: RTs are at the epicenter of patient safety first tirelessly reducing serious safety svents. As patients and families feel safe and trust RTs, then their customer service and clinical skills become obvious. This is important with HCAPS funds at risk. RTs perform daily SBTs as part VAP Bundle. RTs can work with decision support administrators to develop automated monitoring of electronic medical records for SBT compliance and CDC new VAP protocol. This daily triaging surveillance improves compliance dramatically.  This supports quality programs like Anthem Q Hip. Supporting physicians with clinical signs and therapy outcomes while monitoring sputum sample results for organisms will move it from simple pneumonia to a more complex respiratory infection. 
• Information Technology: Most professions are adapting to the advent of electronic healthcare information, but few are fully prepared to embrace this new future. Respiratory care has always embraced innovation in technology and can be expected to continue to do so.
• Application RT is a technology rich field; complex ventilators for all ages providing advanced modes enhanced by graphics.  These technologies are often interfaced with electronic medical records.  The same is true with a variety of ABG machines which have matured into point of care models. PFT machines in the traditional PFT lab setting, inpatient bedside, and offsite physician offices, and video bronchoscope HD capability where images are saved online have expanded the practice of RTs. RTs are in a great position to expand the medical home with vital capacity, peak flows, and Sa02. 
• Flexible and Innovative Care: Those professions with a broader perspective on healthcare outside a specific technical arena would do well here.
• Application: RT is now a cost center not a revenue producer. RT has adapted providing an innovative approach. For example, providing acute care HHN at 50 percent of the pervious frequency (Q8 versus Q4) using a BAN while significantly improving medication deposition (reduces LOS). Compared to similar size hospital it saves $400,000 in 9 months of DRG cost at RMH.

Recently, respiratory therapist was named a "Best Job" by U.S. News and World Report.  So we are in a great place already. Yet our potential is unlimited as we boldly go where no man -- or RT -- has gone before.

Stan Holland is director of pulmonary services, RMH Healthcare, Harrisonburg, VA.

References

1. AARC. 2015 and Beyond: Three conferences that defined the respiratory therapist. Available at: www.aarc.org/resources/2015_conferences. Last accessed Feb. 12, 2013.
2. CDC. Leading causes of death. Available at: www.cdc.gov/nchs/fastats/lcod.htm. Last accessed Feb. 12, 2013.
3. Price Waterhouse Cooper. Creating a sustainable future. Available at: www.pwc.com. Last accessed Feb. 12, 2013.
4. U.S. News and World Report. Respiratory therapist. Available at: http://money.usnews.com/careers/best-jobs/respiratory-therapist. Last accessed Feb. 12, 2013.