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A monumental RT dept challenge, need all the help I can get

By Adrian McDonald posted 08-10-2017 16:38

  
Hi friends. I have a situation on my hands that turns out to be a whole lot larger than originally perceived. I could really use help as I am at a loss here....
As a clinical specialist, part of what my role entails is to identify needs within a hospital and RT dept, and find solutions that work well with all. Level 1 trauma and NICU, Peds and adult CF center, huge hospital--I have discovered a hospital RT dept in a state like I've never seen before. I was in a meeting with an RT supervisor and a veteran RT to discuss the details surrounding secondhand info that they had been sharing equipment between CF kids, specifically our vest therapy device. The meeting was called to find out what their current practices were, and provide education and awareness about why that was detrimental to their patients, and work to provide solutions to prevent that from happening. It was true, we talked through it, and collectively decided on a plan to add additional devices, switch to disposable hoses, and provide inservices to include necessary education about this event. This uncovered the truth about their view/and pulmonary docs views on airway clearance in the adult population--their staff was performing manual CPT on almost all patients, 40 minutes each patient, each treatment-QID... They complained how a lack of CPT consistency is an issue ranging between seasoned therapists and new grads. The only 2 pulm docs (1 is medical director) are checked out as they are both close to retiring. They have zero support for implementing vest therapy in adults, ICUs, or anywhere other than Peds. They are desperate for more staff, new charges, and have no route other than those docs. Now those docs are the intensivists too, and again...have basically checked out of patient care. The director of respiratory does not seem to care about the staff requests, and has a hands off approach to management. He seems to care solely about his job, and zip about his staff or retention. There are no protocols in place, high readmission rates, no coordination with case management, no plans for post acute care, no way to identify high risk patients, and are basically winging it at this point. The staff is genuinely unhappy and does the bare minimum to skate by. The two people I was meeting with were amazing Therapists, but had completely given up hope and had no other answers. 

I committed to these wonderful therapists that I would help them get their dept thriving like never before. They needed a way to implement RT protocols, have a better/more efficient ACT strategy, COPD navigation program development and readmission reducing strategic plan development. 
*The major barrier: the medical director, and RT director...they are both brick walls and have washed his hands of their dept (per their perception). After so many failed attempts, these two have no more fight in them or alternative solutions.

What I need: Who do we get in front of? Staff retention is not important to the hospital. The have low patient and employee satisfaction scores, high turn over, high readmission rates with no real emphasis on even monitoring them; let alone a plan to change them. I would like to build a solid foundation for their dept, and provide the necessary data to prove the need for so many different components for their facility. If the RT director, medical director, and intensivist are not interested...where do we focus our attention? The C-suite? I have made a commitment to develop a plan to turn their department and hospital around, and providing more consistent, world-class, streamlined care for their community. 

To be honest; I am in so far over my head...I didn't realize the depth of this situation until I was already waist deep. In good conscience, I cannot walk away from this. I have to provide them with better than what they have, and will do everything within my power to do so. I am backed by a sales manager and strategic accounts manager. Neither are clinical and are not qualified to provide assistance, but are there for anything.

Please, if anyone can give me any jumping off points...any and all suggestions/help is welcome. Call or email me if needed, I'm always available.

Thanks,
Adrian McDonald, RCP, RRT
SE Field Clinical Specialist, InCourage System
amcdonald@respirtech.com
706.570.9787
6 comments
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Comments

Gregory Rittenhouse
10-24-2018 08:53

You need to go to finance. When you can show how protocols will save the institution big money, that usually gets the attention you need. Sounds like you have some dinosaurs that need to retire.

Wesley Andrews
02-09-2018 10:35

Any update?

Amanda Rose
11-15-2017 11:08

​I have experienced these issues at a previous facility, and I would absolutely agree with previous posters to take these concerns to higher management. Also, I have had success with bringing these protocol request to a medical committee. Check to see if they have one established, and ask to attend one of their meetings. Supply data and research to the committee regarding the need for therapist driven protocols, as well as the effects of readmissions. If you present this material appropriately, then change should soon follow. Type up your own protocols, and present them. They may or may not be utilized, but if you show your persistence you may have some success.

Harold Bence
11-08-2017 20:35

Although this is an older post, it resonates personally and prophetically.  I have had success at what you face, twice; though neither is identical.  I won't waste your time too much, other than to suggest that a C-Suite appointment is a risk worth considering.  It can be enlightening as to the genesis of the apathy or serve to clarify a managerial/ administrative communication chasm.  I will say that our profession is in dire need of real leadership willing to commit to righteous risk in assuring Quality Patient Care, Patient/ Caregiver Safety, and Professionalism(in the form of therapist, patient and strategic initiative- advocacy).

Megan Kelley
10-27-2017 14:20

Sounds tough.  An idea: Why not start with how new protocols are implemented at your facility and go through the committee process to get some RT to assess & treat, or a CPT algorithms-type protocol. This could give your RTs some more autonomy & make them feel that they get to be "real RTs" and gives them some ownership in their pt's care.  See if any of them have a particular topic they're passionate about.  I've seen a single RT get a new position implemented single-handedly (she did the research, worked w/HR herself and put together a COPD Navigator position that our facility previously didn't have).

If you can, get a small "committee" of your RTs together to go over the protocols (this gives them a voice & it also might give you some insight into practices there).  There are numerous studies out there that show that RT-driven protocols reduce ventilator days, improve pt outcomes, etc.  Unfortunately, it sounds like you have to work from the ground up instead of having your leadership back these changes. 

I agree with prev. comments of Ms Flesher.  All of these things can lead to readmissions, bad pt satisfaction scores and a poor reputation for the facility.  Those things are great buzz words/topics for upper levels of administration. Sometimes you have to jump over the mid-level bureaucrats

D'Aun Maestas
09-13-2017 13:11

Yikes! Have you considered contacting the Department of Health and/or JCAHO? That sounds like some SERIOUS problems that you're right to want to address. In addition, CMS and local payors would probably be very interested in the lack of action for preventable readmissions. This would affect the hospital's reimbursement, so the higher-ups at the hospital would DEFINITELY care about this.