slideshow widget

Saturday, June 16, 2012

Useless breathing treatments may never end

I've decided that the people who have the power to improve the profession of respiratory therapy are the same people who have an incentive to keep it as it is.  So while many RTs have made the observation most of what they do is a waste of time or delays time, nothing will change in the near future.

UNLESS...  unless something like what happened during the 1950s happens again.

You see, why would the bosses of the RT cave want to add protocols and educate doctors to get rid of procedures that aren't needed?  You have to realize these are the same folks who have petitioned to get order sets that have breathing treatments automatically ordered for a given diagnosis, as opposed to doing therapies for scientifically proven reasons.

They won't make the needed changes because.... THEY WOULD BE OUT OF A JOB.

The proof is in the pudding that RT Driven protocols reduce unnecessary procedures and reduce hospital costs, yet many small town hospitals don't want them because they fear -- as they say -- they will reduce procedure counts and we would all be out of a job.  Most evidence shows this is not true. No matter what happens, RTs will always be needed.

However, a more confined RT department would quite possibly means RT bosses WOULD BE OUT OF A JOB.  So this is the very reason they don't want to get rid of unnecessary procedures.  They are selfish.  They are afraid an improved RT department would result in them being squeezed out.

That is why when you approach an RT boss they blow off any wines of RT apathy due to useless breathing treatment orders.  Many times my boss has nodded his head in agreement, says changes are coming, and then.... nothing.  Silence.

It's not a coincidence.  It's not because he tried.  It's simply because he doesn't want to make changes.  He's telling you what you want to hear and that's that.

However, in the 1950s and 1960s doctors were ordering IPPB treatments for just about any lung patient.  They were doing this based on some unproven belief the IPPB would force medicine deeper into the lungs and make the medicine work better, and the fake study it would open atelectic lungs.

Yet insurance companies in the 1970s cried foul. They argued that such treatments were expensive.  And back then they paid for every procedure unlike today when they simply pay a flat fee (no thanks to HMOs).  In this way, IPPB therapy became the laughing stock of respiratory therapy.

And it was partially for all the IPPB therapies being ordered just so RT departments could make money that HMOs were created.  Yet instead of getting rid of stupidity it simply exacerbated it.  Surely studies proved IPPB gave 35% less medicine to patients, and IS was better to treat and prevent atelectasis, yet now doctors -- instead of using science, order breathing treatments for any annoying lung sound or lung ailment.

It's to the point it's ridiculous.  Nobody wants to be an RT because of stupid doctor orders.  In the past two days alone I had two different doctors explain to me, using the x-ray, why a patients needed breathing treatments based on infiltrates on the x-ray.  Now how a breathing treatment is going to help this is beyond me.  Yet for some silly made up reason they think it will.

Yet I don't see another 1970 happening mainly because insurance companies aren't paying for these wasted breathing treatments.  And RT bosses don't want to protocol themselves out of work.  So nobody will call doctors on their idiocy.  Hospitals will simply continue to eat up the costs, probably with administrators not even knowing it.

The only hope is the hospital itself, tired of flipping the bill for a department that makes no money, who might step up and end such frivolous therapy.  However, at the same time, HMOs and government agencies only pay for hospital visits when criteria is met.  And, in many cases, breathing treatments are believed -- based on fake science -- to be necessary in order to justify admission to the hospital.  Thus, the hospital won't step in and do anything either.

So we are stuck doing useless breathing treatments for a while.  This will continue until someone comes up and gets the government out of the healthcare business.  It will continue until some smart legislature comes along and decides that doctors and nurses and RTs are better capable of caring for patients at the bedside, rather than old doctors and legislatures sitting around in suits on leather chairs around a table in Washington or Lansing.

In the meantime, the morale of RTs will continue to sink, and bosses will continue to blow them off.


See bronchodilator reform


Anonymous said...

I recently was at a large community hospital that had a protocol for the RTs to override the doctor's ordered frequency on any treatment. Every useless treatment ended up being prn, and they only needed about 8-10 RTs on staff at a given time to cover a 400 bed hospital.

RTs took on more ventilator weaning duties as a result. Instead of doing a 15 minute CPT treatment and a 10 minute nebulizer, they did 30 minute spontaneous weaning trials on most of their mechanically ventilated patients, under their weaning protocol.

Anonymous said...

I've asked my boss about protocols, and it's the same thing..." they are coming." and that's it. The thought up and vanished like a fart in the wind.

Frank Gallegos said...

Well, I'm not a manager but I wrote a complete set of protocols for our small department. They went absolutely nowhere. But one of the realities in small departments is that the staffing is not there for frequency evaluation and spirometries. We may be small but for the most part very busy, so the conundrum is inherent. Too busy/no staff for evaluations, the motivation of each RT staff member to decrease or d/c unwarranted therapy, and physicians that are not exactly progressive that settle in small towns and are not exposed to the latest anything.
All these factors work against a small department trying to progress.