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Monday, April 21, 2008

New Vent protocol biproduct of teamwork

There has been a lot of discussion lately on the blogosphere about how hospitals may be more efficient if there was a more cohesive effort on the part of administrators in involving employees in the process of decision making.

I imagine our hospital is no different in this regards as compared with any other hospital, however we do provide one prime example of what good can come from more than one group of individuals coming together and making decisions to the benefit of all parties involved.

I've written before on this blog about the advantages of the Keystone committee and it's efforts to reduce the incidence of VAP while at the same time saving the hospital millions of dollars per year on wasted medical costs. It's main effort has been by getting administrators, doctors, nurses and respiratory therapists together to figure out a solution.

At Shoreline, the resulting decision was called a ventilator protocol. However, in retrospect, this protocol wasn't really a ventilator protocol, but a ventilator weaning protocol. However, since the protocol has been enacted, the number of days on a ventilator has been chopped by a large margin, and the incidence of VAP has been nearly evaporated.

To further improve the statistics, the doctor in charge of Shoreline's Keystone Committee approached my friend Jane Sage, the RT on the committee, about improving the ventilator protocol. She said that not only did she want it to be a weaning protocol, but she wanted to change the protocol so that RTs could change the rate and tidal volumes based on EtCO2 readings.

Likewise, instead of drawing ABGs every morning and with every vent change, we would now be able to make vent changes without doing the invasive ABG draw, but simply by monitoring the SpO2 and the EtCO2.

These new changes are yet to be approved, but this is a major revelation for an RT department that was protocol depleted as of just two years ago. When Mrs. Sage told me about this doctor approaching her with this new information, I wanted to run out of the hospital and pump my arm into the air shouting ululations like, "Woooo Hoooo."

This, I think, is a quintessential example of what good results can come about when many great minds are put together, as opposed to the administration and doctors getting all the privilege of decision making.

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