organizational theories topic 2
Explain the current benchmarks used in your organization to measure ongoing performance and annual review criteria for an employee position. Describe what tools are used to collect the data, share progress with the employee, and improve overall efficiency of the organization.
Sunday, October 16; 3:10 pm to 5:05 pm (Room 206)
2 5 3 0 3 4 5
LUNG PARTNERS IM PACT O N RED U CTIO N IN 30-DAY C O PD READMISSION
RATES.
R u sse ll A . A c e v e d o , W e n d v F a s c ia , L in d a R au c, J e n n if e r P e d le v ; R e s p ir a to r y C a r e , C r o u s e H o s p ita l,
S y ra c u s e , N Y
Background: L u n g P a r t n e r s P r i m a r y R e s p i r a t o r y
C a r e is a u n i q u e p r im a r y re s p ir a to r y care m o d e l fo r
in -p a tie n t C O P D disease m a n a g em e n t. T h e re is a g re a t n e ed to im prove
m a n a g e m e n t o f C O P D in th e h o sp ita l settin g . In th e hosp ital, care is m ostly
delivered by h o sp ital-b ased physicians aid ed by extenders. T h e re are delays in
care d u e to c o m m u n ic a tio n issues. T h e p lan a t discharge m ay n o t be carried o u t
a t h o m e . In a h o sp italist m o d el, a p a tie n t’s care team is freq u e n tly d ifferen t on
each readm ission. W ith th e g ro w in g n u m b e r o f p a tie n ts a n d th e flat o r decreas
in g n u m b e r o f physicians, the R esp irato ry T h e ra p is t (R T ) is th e logical choice
for C O P D disease m a n a g em e n t. I f th e R T has a p rim ary re la tio n sh ip w ith a
C O P D p a tie n t for all h o sp ita l ad m issions a n d is actively involved in tra n sitio n
to h o m e , th e frag m e n ta tio n o f care can be red u ced . P a tie n ts en ro lled in L u n g
P artn ers will have a P rim a ry R T for th e initial a n d all su b se q u e n t hosp italizatio n s
a n d w ill have L u n g P a rtn e r R T s as a resource w h en th ey are n o t in th e h o spital.
T h e P rim ary R T is p o sitio n e d as the m a jo r physician p a rtn e r in th e m a n a g em e n t
o f C O P D p atien ts. T h e P rim ary R T educates th e p a tie n t o n th e ir disease an d
coaches disease m a n a g em e n t skills. T h e P rim a ry R T screens th e ir p a tie n t for
co -m o rb id itie s. T h e se co -m o rb id ities are p o o rly addressed in th e h o sp ita l setting.
A nxiety a n d D ep ressio n are m a jo r c o -m o rb id ities. Pro to co ls are in place for
p a tie n ts to receive services based o n th e P rim a ry R T ’s assessm ents. T h e im p a c t o f
th is p ro g ram o n 3 0 -d a y readm issions was evaluated. Methods: Since N o v em b er,
2 0 1 4 w e have en ro lled 231 p a tie n ts, w h ich is a b o u t 10% o f o u r C O P D p o p u
la tio n . T h r o u g h o u r Q u a lity Im p ro v e m e n t D e p a rtm e n t w e m easure th e 3 0 -d ay
read m issio n rates for resp irato ry diseases o n L u n g P a rtn e r p a tie n ts, w h ich w e can
d irectly influence. H o sp ital-w id e C M S 3 0 -d a y all cause C O P D readm issions was
also evaluated. Results: F o r L u n g P artn ers p a tie n ts w e saw a sig n ificant red u c
tio n in 3 0 day readm issions d u e to resp irato ry diseases by 2 8 % (p= 0 .0 1 7 6 ). W e
also saw a sig n ificant re d u c tio n in to ta l C O P D C M S readm issions by 2 4 % (p=
0 .0 4 5 ). Conclusion: By p lacin g o u r R T s in a P rim ary R esp irato ry C are m odel
w e w ere able to reduce 3 0 -d a y readm ission rates. T h e R T d e p a rtm e n t has m oved
fro m a task o rie n te d to disease m a n a g e m e n t focus a n d utilizes R T s to the full
e x te n t o f th e ir licensure. R T s can be very successful in th is role.
S p o n so re d R esearch – N o n e
2 5 3 1 3 5 6
BUILDING A STRONG FO UNDATION T O LEAD YOUR TEAM TH R O U G H
TRANSFORMATIONAL CHANGE.
N a ta s h a T v s o n : R e s p ir a to r y C a r e D e p a r t m e n t , C e n t r a l D i v is io n , C a r o l i n a s H e a l t h c a r e S y s te m . C h a r l o t t e ,
N C
Background: H e a lt h c a r e re fo r m h a s c re a te d a n i m m e d ia te d e m a n d fo r
le a d ers to tr a n s itio n a w a y fr o m u tiliz in g o u t d a t e d p e r f o r m a n c e im p r o v e
m e n t s tra te g ie s to so lv e c o m p le x , m u lti- fa c t o ria l issues. L e a d e rs are n o w
e x p e c te d to b e tr a n f o r m a tiv e b y e n g a g in g in s o p h is ti c a te d p r o b le m s o lv in g
te c h n iq u e s t o a c h ie v e s u s ta in a b le a n d m e a n in g fu l c h a n g e . I n o r d e r f o r
R e s p ira to r y T h e r a p y le a d e rs to b u i l d su cc e ssfu l p ro g r a m s t h a t a re r o o te d
in tr a n s f o r m i n g c a re a s o lid in f r a s tr u c tu r e m u s t b e in p la c e to s u p p o r t
r a p id c h a n g e in c lin ic a l p ra c tic e a n d th o u g h t . C a n th e f o u n d a t i o n fo r
tr a n s f o r m a tio n a l c h a n g e b e b u i l t b y re d e s ig n i n g a d e p a r t m e n t ’s h ie ra rc h y
to a llo w fo r g re a te r o p e r a tio n a l e ffic ie n c ies a n d th e c r e a t io n o f v ia b le
stra te g ies to im p r o v e c lin ic a l o u tc o m e s? Method: A s tre n g th s , w eak n esses,
o p p o r tu n i tie s , a n d th re a ts ( S W O T ) an aly sis w as c o n d u c t e d o f th re e , d iv erse
R e s p ira to r y C a r e d e p a r t m e n t s w i t h i n a larg e h e a lth c a re sy ste m to d e te r m in e
i f c re a t in g a d iv is io n a l le a d e rs h ip o rg a n iz a tio n a l s t r u c t u r e w o u l d e lim in a te
silos a n d c re a te s u s ta in a b le o p e r a tio n a l e fficien cies. A c o st an aly sis fo llo w e d
to d e te r m in e t h e i m p a c t to t h e b u d g e t. A th re e p h a se , tw o y e a r im p le m e n
t a tio n s tra te g y w as d e v e lo p e d to h e lp th e te a m m a t e s u n d e r s t a n d a n d a d ju s t
to th e t r a n s itio n as w ell as th e n e w ly c re a te d ro les w i t h i n th e n e w le a d e rsh ip
h ie ra rc h y . I t w as im p le m e n te d a fte r re c eiv in g a p p ro v a l fr o m th e E x e c u tiv e
te a m . Results: A c ro s s -f u n c t io n a l le a d e rs h ip te a m w as c re a te d b y a lig n in g
th r e e s e p a ra te le a d e r s h ip m o d e ls i n to a s in g le C e n t r a l D iv is io n o r g a n iz a tio n
s tru c tu re . A ro b u s t c ro s s -t ra in in g p ro g r a m a n d a C e n t r a l D iv is io n P R N P o o l
w e re c re a te d to assist t h e d iv is io n in a c h ie v in g its 3 % Y T D o v e rtim e goal.
O v e r tim e g o als w e re a c h ie v e d a n d s u s ta in e d fo r 2 0 1 4 a n d 2 0 1 5 . P r e m ie r
p o d u c tiv ity in d e x p e rc e n ta g e s s ta b liz e d fr o m 1 1 8 % to 1 0 5 % b y 2 0 1 5 .
P r e m i e r la b o r e x p e n s e in d e x p e rc e n ta g e s s ta b liz e d f r o m 1 2 4 % to 1 1 2 % b y
2 0 1 5 . T h e C e n t r a l D iv is io n F T E b u d g e t a llo w e d fo r th e u se o f 175 F T E ’s
to flex to v o lu m e a n d s u p p o r t fa c ility sp e c ific s ta ffin g n e ed s. Press G a n e y
te a m m a t e e n g a g e m e n t sco res im p r o v e d fr o m a T i e r 3 sc o re to T i e r 2 d u r i n g
t h e im p l e m e n t a t i o n p e rio d . Conclusion:The C e n t r a l D iv is io n R e s p ira to r y
C a r e D e p a r t m e n t h a s re a liz e d its g o a l o f g a in in g o p e r a tio n a l e ffic ie n c ies a n d
h a s a s tr o n g f o u n d a t i o n b u i l t to s u p p o r t th e d e m a n d s o f h e a l th c a re re fo rm .
S p o n s o re d R e s e a rc h – N o n e
2 5 3 1 4 6 4
IM PLEM ENTATION OF A NEWLY DEVELOPED PATIENT AND FAMILY
SATISFACTION SURVEY FO R RESPIRATORY CARE – A PILO T STUDY.
L isa T v l e r , l o e v lv n n C o v n e , L a u r a S a lo m o n e : R e s p ir a to r y C a r e . T h e C h i l d r e n ’s H o s p ita l o f P h ila d e lp h ia .
C h e r r y H i l l , N J
Background: P a tie n t a n d fam ily satisfaction surveys are o fte n u tilized by
o rg a n iz a tio n s to m easure qu ality a n d satisfaction w ith n u rsin g a n d physician
care. T h e se surveys m o st o fte n do n o t in clu d e qu estio n s reg ard in g respiratory
therap ists (R T ) th erefo re in fo rm a tio n o n satisfaction w ith R T care is o ften
unavailable. A q u a lity p ro je c t targ etin g p a tie n t fam ily satisfaction o f R T care
was in itia te d a n d a R T based survey developed. A p ilo t s tu d y was c o n d u c te d to
assess process m e th o d s (d eliv ery /retu rn ), survey qu estio n s, a n d p relim in ary sat
isfaction scores. Methods: A p a p er based survey was develo p ed u sing m o d ified
q u e stio n s from a valid ated n u rsin g tool. Five q u estio n s u sing a fo u r p o in t Likert
scale (never to always) m e a su rin g c o m m u n ic a tio n practices, con sisten cy o f care,
co u rtesy a n d respect, in fo rm a tio n sharing, a n d ability to voice co n ce rn s w ere
in c lu d e d as well as on e o p e n -e n d e d q u e stio n . Q u e stio n n a ires w ere ra n d o m ly
given o u t o n tw o u n its, p e d ia tric in tensive care u n it (IC U ) a n d an acu te care
u n it (A C U ), to p a tie n ts a n d fam ilies w h o received resp irato ry care services. A
s tan d a rd ize d dialo g u e was p ro v id e d for co n sisten cy in c o m m u n ic a tio n . Surveys
w ere h a n d delivered a n d retrieved by staff. Results: 55 surveys (n= 55) w ere c o m
p leted a n d re tu rn e d . T h e c h art provides th e results for q u estio n s 1 to 5. 4 4 /5 5
(8 0 % ) o f th e o p e n -e n d e d q u e stio n w ere an sw ered w ith positive feedback a n d /
o r areas o f c o n ce rn . N o p a tie n ts o r fam ilies (0 % ) re p o rte d d ifficu lty in u n d e r
s tan d in g , need ed s u p p o rt, o r refused to c o m p le te th e survey. D e liv e ry /re tu rn
p ro v ed to be m o st ch allen g in g for staff, c o m m e n ts in c lu d e d tim in g o f p a tie n t/
p a re n t a p p ro a ch for initial delivery (IC U ) a n d ab ility to re tu rn to p ick up (A C U )
as th e ir c h ie f p ro b lem s. Conclusion: P a tie n t a n d fam ily satisfaction surveys for
resp irato ry care d e p a rtm e n ts can be successfully im p le m e n te d in th e IC U an d
A C U . T h e re are challenges to a d m in isterin g a p a p er based to o l in th e h o spital
setting. W h ile th e p relim in ary overall scores w h ere goo d , c o m m u n ic a tio n an d
con sisten cy in care are p o te n tia l area o f im p ro v em e n t w ork. I t is im p o r ta n t to
n o te , these results m ay be skew ed d u e to R T d riv en p a tie n t selection. F u tu re
w o rk w ill in c lu d e ex p an sio n o f survey use to all p a tie n ts receiving R T services,
fin d in g m o re efficient m eans for delivery a n d re tu rn , a n d to tra c k response rate.
S p o n so re d R esearch – N o n e
2 5 3 1 5 4 9
REDUCING NON-CLINICALLY INDICATED BRO N CH O D ILA TOR THERAPY
ON N O N -IC U FLOORS AT UPHS USING A THERAPIST DRIVEN PRO TO CO L.
M a r g ie P ie rc e . M i c h a e l F ra z e r , H e n r v S m i t h . D a v id D o m z a ls k i. A n d r e w R o ss: R e s p ir a to r y C a r e . H o s p ita l
o f t h e U n iv e r s ity o f P e n n s y lv a n ia , P h ila d e lp h ia , P A
Introduction: R esp irato ry T h e ra p is t d riv en p ro to co ls vs. p h y sician -d irected R T
o rd ers have d e m o n stra te d cost savings to h ospitals a n d im p ro v ed R T resource
u tiliz a tio n in m u ltip le studies. T h e U niv ersity o f P ennsylvania H e a lth System
R T d e p a rtm e n ts p ilo ted a m u lti-h o sp ital b ro n c h o d ila to r p ro to c o l in an effort
to reduce v ariability o f b ro n c h o d ila to r orders, im p ro v e q u a lity o f care an d
R T resource utilizatio n . Methods: O u r m u lti-h o sp ital team used PI m e th o d
ology to assess ro o t causes o f no n -clin ically in d ic a ted b ro n c h o d ila to r orders.
A T D P assessm ent form was develo p ed to stan d ard ize th e assessm ent process.
Phase 1: R T ’s a t H U P , P A H , a n d P P M C used th e assessm ent form for a 2-w eek
d a ta collection p e rio d to assess ap p ro p ria te n e ss o f physician o rd e re d resp irato ry
therap y . D u rin g th e follow ing 8 weeks th e R T used th e T D P fo rm on a p ilo t
m edical u n it a n d in terv en ed w ith rec o m m e n d atio n s fo r o rd e r changes based
o n the assessm ent findings. Phase 2 in c lu d e d C h este r C o u n ty H o sp ital, an d
a d d ed a seco n d m edical u n it to th e original p ilo t u n its. Phase 3 ad d ed surgical
u n its a t H U P a n d P P M C w hile C C H a n d P A H su stain ed th e p ilo t o n m e d
ical u n its. Results: P re-in te rv e n tio n d a ta sho w ed a n average o f 2 0 % o rd ered
b ro n c h o d ila to rs w ere n o t clinically in d ic a ted (range 5 -3 3 % ). D u rin g Phase 1,
n o n -clin ically in d ic a ted b ro n c h o d ila to rs w ere re d u c ed to 10% . D u rin g Phase
2, th e p ro v id e r o rd e r screen was redesigned to im p ro v e accuracy w h e n selecting
freq u en cy o f b ro n c h o d ila to rs. Phase 3 in c lu d e d th e a d d itio n o f 2 surgical units.
H U P red u ced n o n -clin ically in d ic a ted b ro n c h o d ila to r ord ers to 5 % a n d P P M C
to less th a n 8% . U P H S R T d e p a rtm e n ts calculated savings o f $ 8 2 ,5 0 0 in su p p ly
a n d m e d ic atio n costs d u rin g th e p ilo t. Providers re p o rte d im p ro v ed c o m m u n i
catio n , im p ro v ed q u a lity o f care, a n d th a t R T re c o m m e n d atio n s w ere clinically
ap p ro p ria te . Conclusions: T h e U P H S p ro je c t d e m o n stra te d T h e ra p is t D riv en
Pro to co ls red u ce unn ecessary th e ra p y a n d im proves q u ality o f care by ensure
p a tie n ts receive th e a p p ro p ria te resp irato ry therap y . By red esig n in g th e p ro v id er
o rd e r screen, o v e rn ig h t th e ra p y was red u ced a n d frequency o f tre a tm e n ts was
m o re a p p ro p ria te ly o rd ered . R T p a tie n t assessm ents increased a n d a tre n d
to w a rd low er m e d ia n cost p er p a tie n t was id en tified . O rd e rin g pro v id ers a n d
R T ’s re p o rte d positive feedback o f th e p ilo t. U P H S results are in lin e w ith p re
vious o b servations fro m 2 R C T ’s. U P H S R T d e p a rtm e n ts are seeking m edical
b o a rd approval for h o sp ital-w id e R T d riv en b ro n c h o d ila to r p ro to co l.
S p o n so red Research – N o n e
OF33
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individual use.
Sunday, October 16; 3:10 pm to 5:05 pm (Room 206)
2 5 3 0 3 4 5
LUNG PARTNERS IM PACT O N RED U CTIO N IN 30-DAY C O PD READMISSION
RATES.
R u sse ll A . A c e v e d o , W e n d v F a s c ia , L in d a R au c, J e n n if e r P e d le v ; R e s p ir a to r y C a r e , C r o u s e H o s p ita l,
S y ra c u s e , N Y
Background: L u n g P a r t n e r s P r i m a r y R e s p i r a t o r y
C a r e is a u n i q u e p r im a r y re s p ir a to r y care m o d e l fo r
in -p a tie n t C O P D disease m a n a g em e n t. T h e re is a g re a t n e ed to im prove
m a n a g e m e n t o f C O P D in th e h o sp ita l settin g . In th e hosp ital, care is m ostly
delivered by h o sp ital-b ased physicians aid ed by extenders. T h e re are delays in
care d u e to c o m m u n ic a tio n issues. T h e p lan a t discharge m ay n o t be carried o u t
a t h o m e . In a h o sp italist m o d el, a p a tie n t’s care team is freq u e n tly d ifferen t on
each readm ission. W ith th e g ro w in g n u m b e r o f p a tie n ts a n d th e flat o r decreas
in g n u m b e r o f physicians, the R esp irato ry T h e ra p is t (R T ) is th e logical choice
for C O P D disease m a n a g em e n t. I f th e R T has a p rim ary re la tio n sh ip w ith a
C O P D p a tie n t for all h o sp ita l ad m issions a n d is actively involved in tra n sitio n
to h o m e , th e frag m e n ta tio n o f care can be red u ced . P a tie n ts en ro lled in L u n g
P artn ers will have a P rim a ry R T for th e initial a n d all su b se q u e n t hosp italizatio n s
a n d w ill have L u n g P a rtn e r R T s as a resource w h en th ey are n o t in th e h o spital.
T h e P rim ary R T is p o sitio n e d as the m a jo r physician p a rtn e r in th e m a n a g em e n t
o f C O P D p atien ts. T h e P rim ary R T educates th e p a tie n t o n th e ir disease an d
coaches disease m a n a g em e n t skills. T h e P rim a ry R T screens th e ir p a tie n t for
co -m o rb id itie s. T h e se co -m o rb id ities are p o o rly addressed in th e h o sp ita l setting.
A nxiety a n d D ep ressio n are m a jo r c o -m o rb id ities. Pro to co ls are in place for
p a tie n ts to receive services based o n th e P rim a ry R T ’s assessm ents. T h e im p a c t o f
th is p ro g ram o n 3 0 -d a y readm issions was evaluated. Methods: Since N o v em b er,
2 0 1 4 w e have en ro lled 231 p a tie n ts, w h ich is a b o u t 10% o f o u r C O P D p o p u
la tio n . T h r o u g h o u r Q u a lity Im p ro v e m e n t D e p a rtm e n t w e m easure th e 3 0 -d ay
read m issio n rates for resp irato ry diseases o n L u n g P a rtn e r p a tie n ts, w h ich w e can
d irectly influence. H o sp ital-w id e C M S 3 0 -d a y all cause C O P D readm issions was
also evaluated. Results: F o r L u n g P artn ers p a tie n ts w e saw a sig n ificant red u c
tio n in 3 0 day readm issions d u e to resp irato ry diseases by 2 8 % (p= 0 .0 1 7 6 ). W e
also saw a sig n ificant re d u c tio n in to ta l C O P D C M S readm issions by 2 4 % (p=
0 .0 4 5 ). Conclusion: By p lacin g o u r R T s in a P rim ary R esp irato ry C are m odel
w e w ere able to reduce 3 0 -d a y readm ission rates. T h e R T d e p a rtm e n t has m oved
fro m a task o rie n te d to disease m a n a g e m e n t focus a n d utilizes R T s to the full
e x te n t o f th e ir licensure. R T s can be very successful in th is role.
S p o n so re d R esearch – N o n e
2 5 3 1 3 5 6
BUILDING A STRONG FO UNDATION T O LEAD YOUR TEAM TH R O U G H
TRANSFORMATIONAL CHANGE.
N a ta s h a T v s o n : R e s p ir a to r y C a r e D e p a r t m e n t , C e n t r a l D i v is io n , C a r o l i n a s H e a l t h c a r e S y s te m . C h a r l o t t e ,
N C
Background: H e a lt h c a r e re fo r m h a s c re a te d a n i m m e d ia te d e m a n d fo r
le a d ers to tr a n s itio n a w a y fr o m u tiliz in g o u t d a t e d p e r f o r m a n c e im p r o v e
m e n t s tra te g ie s to so lv e c o m p le x , m u lti- fa c t o ria l issues. L e a d e rs are n o w
e x p e c te d to b e tr a n f o r m a tiv e b y e n g a g in g in s o p h is ti c a te d p r o b le m s o lv in g
te c h n iq u e s t o a c h ie v e s u s ta in a b le a n d m e a n in g fu l c h a n g e . I n o r d e r f o r
R e s p ira to r y T h e r a p y le a d e rs to b u i l d su cc e ssfu l p ro g r a m s t h a t a re r o o te d
in tr a n s f o r m i n g c a re a s o lid in f r a s tr u c tu r e m u s t b e in p la c e to s u p p o r t
r a p id c h a n g e in c lin ic a l p ra c tic e a n d th o u g h t . C a n th e f o u n d a t i o n fo r
tr a n s f o r m a tio n a l c h a n g e b e b u i l t b y re d e s ig n i n g a d e p a r t m e n t ’s h ie ra rc h y
to a llo w fo r g re a te r o p e r a tio n a l e ffic ie n c ies a n d th e c r e a t io n o f v ia b le
stra te g ies to im p r o v e c lin ic a l o u tc o m e s? Method: A s tre n g th s , w eak n esses,
o p p o r tu n i tie s , a n d th re a ts ( S W O T ) an aly sis w as c o n d u c t e d o f th re e , d iv erse
R e s p ira to r y C a r e d e p a r t m e n t s w i t h i n a larg e h e a lth c a re sy ste m to d e te r m in e
i f c re a t in g a d iv is io n a l le a d e rs h ip o rg a n iz a tio n a l s t r u c t u r e w o u l d e lim in a te
silos a n d c re a te s u s ta in a b le o p e r a tio n a l e fficien cies. A c o st an aly sis fo llo w e d
to d e te r m in e t h e i m p a c t to t h e b u d g e t. A th re e p h a se , tw o y e a r im p le m e n
t a tio n s tra te g y w as d e v e lo p e d to h e lp th e te a m m a t e s u n d e r s t a n d a n d a d ju s t
to th e t r a n s itio n as w ell as th e n e w ly c re a te d ro les w i t h i n th e n e w le a d e rsh ip
h ie ra rc h y . I t w as im p le m e n te d a fte r re c eiv in g a p p ro v a l fr o m th e E x e c u tiv e
te a m . Results: A c ro s s -f u n c t io n a l le a d e rs h ip te a m w as c re a te d b y a lig n in g
th r e e s e p a ra te le a d e r s h ip m o d e ls i n to a s in g le C e n t r a l D iv is io n o r g a n iz a tio n
s tru c tu re . A ro b u s t c ro s s -t ra in in g p ro g r a m a n d a C e n t r a l D iv is io n P R N P o o l
w e re c re a te d to assist t h e d iv is io n in a c h ie v in g its 3 % Y T D o v e rtim e goal.
O v e r tim e g o als w e re a c h ie v e d a n d s u s ta in e d fo r 2 0 1 4 a n d 2 0 1 5 . P r e m ie r
p o d u c tiv ity in d e x p e rc e n ta g e s s ta b liz e d fr o m 1 1 8 % to 1 0 5 % b y 2 0 1 5 .
P r e m i e r la b o r e x p e n s e in d e x p e rc e n ta g e s s ta b liz e d f r o m 1 2 4 % to 1 1 2 % b y
2 0 1 5 . T h e C e n t r a l D iv is io n F T E b u d g e t a llo w e d fo r th e u se o f 175 F T E ’s
to flex to v o lu m e a n d s u p p o r t fa c ility sp e c ific s ta ffin g n e ed s. Press G a n e y
te a m m a t e e n g a g e m e n t sco res im p r o v e d fr o m a T i e r 3 sc o re to T i e r 2 d u r i n g
t h e im p l e m e n t a t i o n p e rio d . Conclusion:The C e n t r a l D iv is io n R e s p ira to r y
C a r e D e p a r t m e n t h a s re a liz e d its g o a l o f g a in in g o p e r a tio n a l e ffic ie n c ies a n d
h a s a s tr o n g f o u n d a t i o n b u i l t to s u p p o r t th e d e m a n d s o f h e a l th c a re re fo rm .
S p o n s o re d R e s e a rc h – N o n e
2 5 3 1 4 6 4
IM PLEM ENTATION OF A NEWLY DEVELOPED PATIENT AND FAMILY
SATISFACTION SURVEY FO R RESPIRATORY CARE – A PILO T STUDY.
L isa T v l e r , l o e v lv n n C o v n e , L a u r a S a lo m o n e : R e s p ir a to r y C a r e . T h e C h i l d r e n ’s H o s p ita l o f P h ila d e lp h ia .
C h e r r y H i l l , N J
Background: P a tie n t a n d fam ily satisfaction surveys are o fte n u tilized by
o rg a n iz a tio n s to m easure qu ality a n d satisfaction w ith n u rsin g a n d physician
care. T h e se surveys m o st o fte n do n o t in clu d e qu estio n s reg ard in g respiratory
therap ists (R T ) th erefo re in fo rm a tio n o n satisfaction w ith R T care is o ften
unavailable. A q u a lity p ro je c t targ etin g p a tie n t fam ily satisfaction o f R T care
was in itia te d a n d a R T based survey developed. A p ilo t s tu d y was c o n d u c te d to
assess process m e th o d s (d eliv ery /retu rn ), survey qu estio n s, a n d p relim in ary sat
isfaction scores. Methods: A p a p er based survey was develo p ed u sing m o d ified
q u e stio n s from a valid ated n u rsin g tool. Five q u estio n s u sing a fo u r p o in t Likert
scale (never to always) m e a su rin g c o m m u n ic a tio n practices, con sisten cy o f care,
co u rtesy a n d respect, in fo rm a tio n sharing, a n d ability to voice co n ce rn s w ere
in c lu d e d as well as on e o p e n -e n d e d q u e stio n . Q u e stio n n a ires w ere ra n d o m ly
given o u t o n tw o u n its, p e d ia tric in tensive care u n it (IC U ) a n d an acu te care
u n it (A C U ), to p a tie n ts a n d fam ilies w h o received resp irato ry care services. A
s tan d a rd ize d dialo g u e was p ro v id e d for co n sisten cy in c o m m u n ic a tio n . Surveys
w ere h a n d delivered a n d retrieved by staff. Results: 55 surveys (n= 55) w ere c o m
p leted a n d re tu rn e d . T h e c h art provides th e results for q u estio n s 1 to 5. 4 4 /5 5
(8 0 % ) o f th e o p e n -e n d e d q u e stio n w ere an sw ered w ith positive feedback a n d /
o r areas o f c o n ce rn . N o p a tie n ts o r fam ilies (0 % ) re p o rte d d ifficu lty in u n d e r
s tan d in g , need ed s u p p o rt, o r refused to c o m p le te th e survey. D e liv e ry /re tu rn
p ro v ed to be m o st ch allen g in g for staff, c o m m e n ts in c lu d e d tim in g o f p a tie n t/
p a re n t a p p ro a ch for initial delivery (IC U ) a n d ab ility to re tu rn to p ick up (A C U )
as th e ir c h ie f p ro b lem s. Conclusion: P a tie n t a n d fam ily satisfaction surveys for
resp irato ry care d e p a rtm e n ts can be successfully im p le m e n te d in th e IC U an d
A C U . T h e re are challenges to a d m in isterin g a p a p er based to o l in th e h o spital
setting. W h ile th e p relim in ary overall scores w h ere goo d , c o m m u n ic a tio n an d
con sisten cy in care are p o te n tia l area o f im p ro v em e n t w ork. I t is im p o r ta n t to
n o te , these results m ay be skew ed d u e to R T d riv en p a tie n t selection. F u tu re
w o rk w ill in c lu d e ex p an sio n o f survey use to all p a tie n ts receiving R T services,
fin d in g m o re efficient m eans for delivery a n d re tu rn , a n d to tra c k response rate.
S p o n so re d R esearch – N o n e
2 5 3 1 5 4 9
REDUCING NON-CLINICALLY INDICATED BRO N CH O D ILA TOR THERAPY
ON N O N -IC U FLOORS AT UPHS USING A THERAPIST DRIVEN PRO TO CO L.
M a r g ie P ie rc e . M i c h a e l F ra z e r , H e n r v S m i t h . D a v id D o m z a ls k i. A n d r e w R o ss: R e s p ir a to r y C a r e . H o s p ita l
o f t h e U n iv e r s ity o f P e n n s y lv a n ia , P h ila d e lp h ia , P A
Introduction: R esp irato ry T h e ra p is t d riv en p ro to co ls vs. p h y sician -d irected R T
o rd ers have d e m o n stra te d cost savings to h ospitals a n d im p ro v ed R T resource
u tiliz a tio n in m u ltip le studies. T h e U niv ersity o f P ennsylvania H e a lth System
R T d e p a rtm e n ts p ilo ted a m u lti-h o sp ital b ro n c h o d ila to r p ro to c o l in an effort
to reduce v ariability o f b ro n c h o d ila to r orders, im p ro v e q u a lity o f care an d
R T resource utilizatio n . Methods: O u r m u lti-h o sp ital team used PI m e th o d
ology to assess ro o t causes o f no n -clin ically in d ic a ted b ro n c h o d ila to r orders.
A T D P assessm ent form was develo p ed to stan d ard ize th e assessm ent process.
Phase 1: R T ’s a t H U P , P A H , a n d P P M C used th e assessm ent form for a 2-w eek
d a ta collection p e rio d to assess ap p ro p ria te n e ss o f physician o rd e re d resp irato ry
therap y . D u rin g th e follow ing 8 weeks th e R T used th e T D P fo rm on a p ilo t
m edical u n it a n d in terv en ed w ith rec o m m e n d atio n s fo r o rd e r changes based
o n the assessm ent findings. Phase 2 in c lu d e d C h este r C o u n ty H o sp ital, an d
a d d ed a seco n d m edical u n it to th e original p ilo t u n its. Phase 3 ad d ed surgical
u n its a t H U P a n d P P M C w hile C C H a n d P A H su stain ed th e p ilo t o n m e d
ical u n its. Results: P re-in te rv e n tio n d a ta sho w ed a n average o f 2 0 % o rd ered
b ro n c h o d ila to rs w ere n o t clinically in d ic a ted (range 5 -3 3 % ). D u rin g Phase 1,
n o n -clin ically in d ic a ted b ro n c h o d ila to rs w ere re d u c ed to 10% . D u rin g Phase
2, th e p ro v id e r o rd e r screen was redesigned to im p ro v e accuracy w h e n selecting
freq u en cy o f b ro n c h o d ila to rs. Phase 3 in c lu d e d th e a d d itio n o f 2 surgical units.
H U P red u ced n o n -clin ically in d ic a ted b ro n c h o d ila to r ord ers to 5 % a n d P P M C
to less th a n 8% . U P H S R T d e p a rtm e n ts calculated savings o f $ 8 2 ,5 0 0 in su p p ly
a n d m e d ic atio n costs d u rin g th e p ilo t. Providers re p o rte d im p ro v ed c o m m u n i
catio n , im p ro v ed q u a lity o f care, a n d th a t R T re c o m m e n d atio n s w ere clinically
ap p ro p ria te . Conclusions: T h e U P H S p ro je c t d e m o n stra te d T h e ra p is t D riv en
Pro to co ls red u ce unn ecessary th e ra p y a n d im proves q u ality o f care by ensure
p a tie n ts receive th e a p p ro p ria te resp irato ry therap y . By red esig n in g th e p ro v id er
o rd e r screen, o v e rn ig h t th e ra p y was red u ced a n d frequency o f tre a tm e n ts was
m o re a p p ro p ria te ly o rd ered . R T p a tie n t assessm ents increased a n d a tre n d
to w a rd low er m e d ia n cost p er p a tie n t was id en tified . O rd e rin g pro v id ers a n d
R T ’s re p o rte d positive feedback o f th e p ilo t. U P H S results are in lin e w ith p re
vious o b servations fro m 2 R C T ’s. U P H S R T d e p a rtm e n ts are seeking m edical
b o a rd approval for h o sp ital-w id e R T d riv en b ro n c h o d ila to r p ro to co l.
S p o n so red Research – N o n e
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