Impact of Respiratory Therapist Education on Discharge Outcomes of Subjects With COVID-19

Abstract

Background:

The American Association for Respiratory Care has a position statement for the entry-level academic degree to be a baccalaureate degree by the year 2030. No published literature demonstrates that clinical outcomes improve when care is provided by RTs with baccalaureate degrees or higher. The aim of this study was to determine whether RTs holding advanced degrees or RTs who completed adult acute care competencies impacted the discharge outcomes and duration of stay of patients with COVID-19.

Methods:

Data were pulled from the electronic health record for a census of intubated subjects with confirmed COVID-19 diagnosis who were admitted to the hospital for at least 3 days between March and May 2020. Study was approved by the institutional review board. The academic degree held by each RT at the time of the study was pulled from the departmental personnel files and coded as an advanced degree (baccalaureate or higher) or associate degree. A threshold of ≥85% of ventilator assessments per subject was used to identify those who received care from RTs with advanced degrees. Discharge outcomes were considered good if the subject’s hospital discharge was directly to home, compromised if discharged to a non-acute care facility, and poor if the subject was referred to hospice or died. A time-series multistate regression model was run to determine the impact of academic degree, adult critical care competency, BMI, and PaO₂/FIO₂ ratio on the discharge outcomes using α = 0.05.

Results:

A total of 260 patients with median age of 59 years were enrolled. Patient demographic information appears in Table 1. The time-series multistate regression model showed that patients cared by RTs with an advanced academic degree had more than eight times the rate of discharge to home and lower ventilator days (P = .005) than RTs without advanced degrees. Similar findings occurred with completion of an adult critical care competency, as shown in Table 2. Lower PaO₂/FIO₂ ratio was a predictor of poor outcomes.

Conclusions:

Improved discharge outcomes and reduced duration of stay occurred when mostly RTs with baccalaureate or higher degrees cared for mechanically ventilated patients with COVID-19. Stronger findings emerged when patients received care from RTs who completed an adult critical care ventilator competency. Patients with severe acute respiratory illness may benefit from care provided by respiratory care departments that employ 85% of RTs with baccalaureate degrees or higher and conduct annual ventilator competencies.