Pierce Margarete, Gudowski Steven W, Roberts Karsten J, Jackominic Anthony, Zumstein Karen K, Shuttleworth Amanda, Ho Joshua, Susser Phillip, Parikh Alomi, Chandler John M, Huffenberger Ann Marie, Scott Michael J, Hanson C William, Laudanski Krzysztof
Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
J Clin Med. 2022 Jan 29;11(3):718. doi: 10.3390/jcm11030718.
A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio-visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as "routine" based on established workflows, 4.71% as "urgent", 0.26% "emergent", and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient-ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.
在新冠疫情期间，作为宾夕法尼亚大学已建立的远程重症监护病房（PENN E-LERT）服务的一部分，设立了一项每周7天、每天24小时的远程医疗呼吸治疗师（eRT）服务，为5家医院和320张重症监护床位提供服务，以代替基于病房的呼吸治疗师提供有效的远程护理。eRT干预措施是循证护理套餐的组成部分，包括呼吸机撤机方案、低潮气量方案、管道通畅性以及拔管检查表。此外，还包括对患者的主动查房，包括呼吸机检查。使用标准化的数据收集表来促进病历审查、直接视听检查或与工作人员的直接互动。2020年5月，共进行了1548次干预，其中93.86%根据既定工作流程被编码为“常规”，4.71%为“紧急”，0.26%为“突发”，1.17%缺少描述符。根据编码干预的数量，我们跟踪了系统中新冠患者的数量。平均每次干预耗时6.1±3.79分钟。在所有互动中，16%的情况未与床边团队进行沟通。在所有干预中，eRT与医院内部呼吸治疗师（RT）联系的占66.6%，其次是住院医生（9.8%）、高级执业提供者（APP；2.8%）和注册护士（2.6%）。大多数互动通过电话（88%）、安全短信（16%）或视听远程医疗重症监护病房平台（1.7%）进行。总共花费了5115分钟用于床边临床医生原本会执行的任务，减少了他们接触新冠病毒的机会。eRT服务在几次紧急和突发的关键干预中发挥了作用。这项研究表明，eRT服务可以支持床边RT提供者，有效监测最佳实践套餐，并进行患者-呼吸机评估。它在某些紧急情况下有效，并减少了RT接触新冠病毒的机会。我们计划将该服务作为综合RT服务的一部分继续下去，并希望为其他机构开发类似服务提供一个框架。
