So far every time I have made a suggestion to a hospitalist it has been accepted. In fact, recently I asked a hospitalist about changing ventilator settings, and he said, "You guys are as well trained and educated as we are on that."
Example #1: 0600 order was written as tidal volume 500 and a rate of 16. Night shift RT had already set the vent at a tidal volume of 450 and a rate of 12 at 0200 based on the ER ventilator protocol (which is essentially RT to set up and titrate). At 0500 an ABG shows normal ABGs. As the day shift RT, I explained what the night shift RT did, and what the night shift hospitalist ordered, and the day shift hospitalist said, "Hey, that sounds great! I tend to like low tidal volumes anyway."
Example #2: Hospitalist orders an SBT (spontaneous breathing trial). I did it at a pressure support of 5 and a PEEP of 5 based on our protocol. The doctor ordered the PS to be at 10, so I basically ignored his order. I could have just not said anything, but I did. The Dr. said, "Hey, that sounds great!"
Example #3: Here are the patient's gases:
- CO2 of 87
- PO2 of 60
- Spo2 of 89
The patient has end stage COPD. He was put on a 50% venti mask six days prior to maintain an SpO2 of at least 90%. A new hospitalist wrote an order to decrease to 4lpm. I explained to the doctor that he has been on the mask for six days with no ill effect. His CO2 was 80 when he was put on it, and it's still 80. He said, "I'm fine with that."
So, so far all but good experience. We at the RT cave love our hospitalists.
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