October is National Healthy Lung Month
~ The Role of the Respiratory Therapist in Healthcare Services ~
By Jamie Sahli, BS, RRT, AE-C ~
The role of the Respiratory Therapist in the healthcare setting has changed drastically over the years. The first “Oxygen Orderlies” became Inhalation Therapists and established their own professional society in 1947. According to an American Association for Respiratory Care (AARC) historian, it was physicians who drove the field. In particular, Dr. Levine out of Chicago needed individuals to supervise his post-operative patients to prevent bronchial obstruction. He quotes “we discovered that the important part of thoracic surgery was not so much what was done on the operating table, but what was done after to prevent post-operative pneumonia by controlling secretions and breathing.” There are now approximately 208,000 therapists in the U.S., 2,500 of those individuals practice in Colorado.
Skilled clinicians care for a variety of patients. Therapists have a strong presence in neonatal intensive care units as they ventilate the tiniest of lungs. They deliver surfactant and ventilate premature babies weighing as little as 450 grams which is just less than one pound. Specialized care from Respiratory Therapists helps keep these babies alive and well. In addition, therapists work with pediatric patients to manage post-operative cases from cardiac surgery to neuromuscular spinal surgeries. Therapists play a vital role in bronchial airway clearance and inhaled medication delivery to patients with Cystic Fibrosis and Bronchopulmonary Dysplasia, many require long-term tracheotomy and mechanical ventilation to survive. There is a specialty credential from the National Board for Respiratory Care that validates their competency working with babies and children. This specialty credential is called the Neonatal Pediatric Specialists (NPS).
Respiratory Therapists spend a great deal of time managing patients with Chronic Obstructive Pulmonary Disease (COPD) and Acute Respiratory Distress Syndrome (ARDS) in Intensive Care Units (ICUs). COPD is now the third leading cause of death in the U.S. and is on the rise. ARDS is a serious disease in which the lungs become inflamed and filled with fluid. ARDS was discovered and named by Dr. Thomas Petty, a well known pulmonary physician that practiced and taught at University of Colorado Hospital. Dr. Petty was a leading physician for not only the Respiratory Therapy profession, but also an advocate for patients with lung disease. His legacy leaves an energetic group, the Colorado Lung Health Connection (CLHC) that plans an annual “Moving Mountains” conference for patients by patients.
In the ICU, Respiratory Therapists are responsible for managing ventilators, drawing blood gases, initiating oximetery and capnography, managing artificial airways, as well as taking care of oxygen, aerosol, and airway clearance therapies. The technology has changed for respiratory care equipment, and so the education for respiratory therapists has seen an increase in rigor. Many therapists have taken a new credential from the NBRC that validates their competency working with adult critically ill patients. This credential is called the Adult Critical Care Specialists (ACCS).
Therapists specializing in diagnostics perform a series of pulmonary function testing including the main diagnostic tool for COPD, spirometry. Lung function tests measure how well the lungs expand, empty and diffuse pulmonary gases. Therapists also test how well lungs respond to medications or exercise. Many therapists earn a specialty credential from the NBRC called the Certified or Registered Pulmonary Function Technologist (CPFT or RPFT). In addition to working in a pulmonary function lab, therapist specializing in diagnostics may also test patients for sleep apnea using polysomnography. Obstructive sleep apnea (OSA) is a condition in which patients stop breathing due to excessive amounts of tissue. Sleep apnea leads to cardiovascular disease and other complications after surgery including low oxygen to the tissues and increased hospital stays. There is also a specialty credential from the NBRC called the Sleep Disorder Specialists (SDS).
Respiratory Therapists were created to provide therapy for post-op patients in the inpatient setting. While inpatient care continues to be an important role of the Respiratory Therapist, there is a growing need to provide managed care for patients with chronic disease such as COPD, cystic fibrosis, asthma, pulmonary fibrosis and pulmonary hypertension. In 2014, the U.S. government rolled out the Affordable Care Act in an attempt to expand healthcare coverage to more Americans. Implications for healthcare providers is less reimbursement in the inpatient setting, hoping care will be provided only if it is proven effective and cheaper. The new care model also carries the goal of keeping patients with chronic disease out of the hospital and well in their home. This may be accomplished through pulmonary rehabilitation programs and home respiratory therapy provided by a coordinated multidisciplinary team. The shift from inpatient to outpatient management for pulmonary patients is expected from all healthcare providers yet implementation continues to develop.
I feel fortunate yet apprehensive to practice as a licensed RT in this changing environment of healthcare and reimbursement. The care I have learned and provided to patients will change, and I am unsure what it will look like in the future. I do appreciate being a part of an active community where Respiratory Therapists and their patients collaborate. There are a number of groups such as the Colorado Society for Respiratory Care, Colorado Lung Health Connection, and various Pulmonary Rehab support groups where Dr. Petty’s legend lives on. Together we can hope to create a better environment for our patients that live with lung disease and continue to climb mountains, oxygen tanks welcome! Further information may be found on the Colorado Lung Health Website online at: www.coloradolunghealth.org or by calling Joy Grinstead 303-771-1628.