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Wednesday, January 9, 2008

Fewer Vent paitents is ailing small town RT Caves

It used to be really busy here at Shoreline. In fact, even back two years ago I remember being so busy I didn't even have the time to read a chapter of whatever book I stuffed into my tote bag.

In the past year, however, I feel like I could literally sit here in the RT Cave and write an entire novel -- each night.

About a week ago we had a patient on the ventilator when I arrived. Don't laugh, but I had to actually search for the silence button. And then, that same night, I had to set up a vent. My brain was a little rusty, and I couldn't remember the formula for determining ideal body weight.

Other than that I was in RT Heaven that night; it felt great to be doing real RT work.

But that was one night. The next night we were back to our usual 10 patients, 9-10 of whom giving the treatment was equivalent to having them drink a glass of water for pneumonia.

I saw a recent trends report for Shoreline, and it went something like this: 99 vents set up in2000, 98 set up in 2001, 88 in 2002, 80 in 2003, 84 in 2004, 74 in 2005, 48 in 2006, 24 in 2007.

None the downward trend.

What's the reason for this? Total patient admissions have been consistent, so it's not because people are choosing a different hospital. BiPAP set-ups have been consistent, so it's not because the BiPAP is saving people from going on vents.

Another trend is length of stay on the ventilators, which has dramatically dropped from an average of 100 hours per patient all the way down to 21 hours per patient. This, I believe, can be attributed to a variety of factors, including quality staff, great doctors who are more receptive to protocols, and new microprosessor ventilators.

So, technology can be attributed to some of our decline, but what about the lack of ventilators overall trending down? I have theories here too.

Many of the most critical patients are being shipped to specialty hospitals, i.e. cardiac, neuro, trauma. While we used to take care of more cardiac patients, it doesn't make much sense to keep them here when they can be minutes away from a cardiac doctor.

Not that we still couldn't take care of these patients here. We could.

Likewise, more and more patients are prevented from moving to the critical care floor due to early intervention and treatment. This goes along with improved education, quality of care and increased vigilance regarding patient's showing early signs of problems and nipping them in the bud.

So, now I sit here with seven or eight expensive state of the art ventilators collecting dust in the back closet. I'm prepared to take on an epidemic, and yet here I sit while my skills atrophy.

I've written before on these pages how we have been trying to get protocols, and how the RT leaders are against them more so because they are afraid they will result in less work for us. Well, what better time than the present for them to make their case.

I know from reading other blogs, and talking with other therapists, that we are not alone in this.

This is part of a developing trend for small town hospitals. In fact, it might be the wave of the future. We might never get back to the level of having 100 vents in a year again, even though we are more than equipped to handle it.

The reason I saw these statistics is because the admins are concerned about recruiting RTs here in the future. Are we going to be able to recruit RTs to a hospital when they know they'd just sit around waiting for an emergency to happen, as my main character does in "The RT Cave in the Year 2020."

If you're a young RT fresh out of RT school who wants to keep his skills up, a small town RT cave may not be for you anymore. But trust me when I say that wasn't true two years ago, and it definitely wasn't true when I started here.

Rumor has it the admins are aware of how a high quality area is being underutilized, and are seeking to bring something in to generate some business for us. That in itself is a scary idea, especially if this downward trend is an aberration.


Djanvk said...

I'm with you. We only have a totaly of 3 vents inhouse to utilize. I've heard that this hospital was a lot busier in the past lack of vent patients might be due to the ability of emergency crews and helicopter to be able to transport to larger facilities with the more critical patients. We have a large University hospital just 60 minutes north of here. Helicopter could make it pretty quick.

Glenna said...

I work at a larger facility so we can easily have 20 vents going in total between all of the units but we have just as many or more BiPaps running at the same time. My hospital and docs are very progressive in BiPap use to keep people off vents. I've seen a lot of people with gases that school taught us should be automatic intubation, start to bring their pH's up within hours of being BiPap'd. I think it's a wonderful thing to save people from the tube and the possibility of VAPS.

But even with less vents, COPDers will always give us job security. :-)

mielikki said...

I work at a small hospital, but we don't ship anyone unless they are trauma. Our vent load goes up and down, but there always seems to be one or two hanging around my wee ICU

Stephen said...

Hi! I just discovered your blog through "Asthma Mom" ..Good stuff!

I'm a recently retired ( but still licensed) RT from the San Francisco area.

I'll be a frequent visitor to you blog.