How the Kentucky Children's Hospital RT Team Mastered Daunting Growth and Change

Abstract

Background:

In 2018, the KCH Respiratory Therapy (RT) team grew by 50% and transitioned to a vertical hospital environment. Several novel approaches were taken to make these changes successful for staff with minimal cost. In 2017, the KCH RT team was an experienced group of 30 respiratory therapists; 50% of the team had 10 or more years of experience as pediatric therapists. The RT team was bolstered by geographic proximity to each other throughout a shift. Plans to open a 72 bed single patient room NICU presented numerous threats. The new vertical geography meant that the RT team would lose their window on each other. RT staff would need to stay in their NICU “neighborhood” to assist nursing with patient monitoring in the single patient room environment. After the NICU move, there would only be 2 RTs left for all of PICU, progressive care and acute care. Although 13.5 FTEs were approved to address these concerns, adding so many new staff at once posed a significant challenge, especially with the pending geographical changes.

Methods:

A KCH RT Education Steering team was assembled in July 2017. This team re-wrote the orientation plan for new hires and participated in interviews. The KCH Lead RT role was established to provide clinical and logistical support to the shift. A Lead is assigned around the clock; the Lead team members work as regular staff therapists when not assigned to the Lead role for a shift. A start of shift huddle was implemented. The Leads function as clinical experts and are a lifeline of support for new therapists. The Lead also arranges just in time training for staff when unique or less common patient needs arise.

Results:

Fifteen therapists on-boarded to KCH between January 2018 and July 2018. One had prior pediatric ICU experience, 2 had prior adult ICU experience, and 12 were new graduates. The education committee and the Lead RT role augmented staff ownership of transition needs.

Conclusions:

The combined efforts of the education team and the introduction of the Lead RT as a clinical expert and peer mentor resulted in faster acclimation of new hires to all areas of KCH. Prior, a new graduate typically took two years to fully acclimate to NICU and PICU. 14 of the 15 new hires were taking full assignments in NICU by the end of three months. 80% of the new hires now attend deliveries, far sooner than the usual 12 months. The Lead therapists report increased job satisfaction. Employee engagement scores increased by 7%.