Abstract
Background:
A virtual critical care respiratory program was evaluated on the impact of spontaneous breathing trial (SBT) compliance and ventilator management in the critical care setting. This program can improve overall VLOS and management by enforcing best practice guidelines.
Methods:
A retrospective cohort study was performed. All vented subjects prior to implementation, October to December 2017, were identified. Every third subject was selected to be analyzed for compliance with the systems Vent liberation protocol and actively weaning. Subjects were also evaluated for possible retrial opportunities later within the same day. The telehealth respiratory therapy program was piloted beginning January 2018. All patients requiring mechanical ventilation from March to May were identified, selected and analyzed the same way as the pre-implementation subjects. Upon the implementation of the program, Virtual Respiratory Therapist (VRT) partnered with the ICU's in the use of the protocol. VRTs assessed all vented patients daily for proper use of the protocol. The VRT would contact the bedside respiratory therapist to discuss the plan of weaning, re-addressing SBT readiness, and arranging a re-trial to aid in decreasing VLOS. The VRT documented the plan and followed up to assure the plan was carried out when appropriate.
Results:
230 of 700 vented subjects were selected for October thru December 2017 for pre-implementation analysis and 550 of 1750 were selected for March thru May 2018 for post-implementation analysis. Retrials are defined as a second trial or attempt a trial for subjects meeting the SAT/SBT criteria per protocol, who may have failed the initial daily trial, or who did not meet criteria previously but now have been managed up. A considerable increase in compliance in the use of the protocol and number of SBT re-trails done was noted with the addition of VRTs. Tableau's, the systems critical care data base, SBT data compliance rates pre-VRT program were 85% in October 86% in November, and 86% in December. Post-implementation compliance improved to 91% March, 91% April, and 92% May.
Conclusions:
The addition of respiratory therapists to the virtual critical care team to aid in the management of mechanically ventilated subjects had a positive contribution to an increase in SAT/SBT protocol compliance and will subsequently affect VLOS in a positive manner as the Tableau vent days for March 2017 were 3.6 and decreased for March 2018 to 2.95 days
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