RT Best2012

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RT’S BEST OF 2012 PROGRAM PANEL
Kenneth J. Miller,
MEd, RRT-NPS, AC-E
Clinical Educator
Lehigh Valley Health Network
Mark Grzeskowiak,
RCP, RRT, FAARC
Manager, Education & Quality,
Respiratory Care Services
Long Beach Memorial
Medical Center
Daniel J. Farrell,
MEd, RRT-NPS, CPFT, EMT-1, RCP
Professor Emeritus,
Respiratory Care and Allied Health
Orange Coast College
Michael J. Hewitt,
RRT-NPS, FAARC, FCCM
Critical Care/Trauma
Specialist & Consultant
Tampa, Fla
Paul Nuccio,
MS, RRT, FAARC
Director of Pulmonary Services
Brigham and Women’s Hospital
& Dana-Farber Cancer Institute
18 RT Magazine | Best of 2012
NOMINEES FOR BEST OF 2012 RESpIRaTORy caRE DEpaRTMENTS
Adventist GlenOaks Hospital
Glendale Heights, IL
www.keepingyouwell.com
Airway Oxygen Inc Homecare
Wyoming, MI
www.airwayoxygeninc.com
Akron Children’s Medical Center
Akron, OH
www.akronchildrens.org
Alvarado Hospital Pulmonary
Department
San Diego, CA
www.alvaradohospital.com
Arrowhead Regional Medical
Center - Respiratory Care Services
Colton, CA
www.arrowheadmedcenter.org
Atenas College - Cardio
Respiratory Program
Manatí, Puerto Rico
www.atenascollege.edu
Baptist Health South Florida
Coral Gables, FL
www.baptisthealth.net
Bay Medical Center
Panama City, FL
www.baymedical.org
Billings Clinic
Billings, MT
www.billingsclinic.com
Blake Medical Center
Bradenton, FL
www.blakemedicalcenter.com
Bolivar Medical Center -
Respiratory Therapy Department
Cleveland, MS
www.bolivarmedical.com
Bradley County Medical Center
Warren, AR
www.bradleycountymedicalcenter.com
Brentwood Subacute
Healthcare Center
Burbank, IL
www.brentwoodsahcc.com
Bristol Hospital
Bristol, CT
www.bristolhospital.org
Centerpoint Medical Center
Independence, MO
www.centerpointmedical.com
Cherokee Nation
WW Hastings Hospital
Tahlequah, OK
www.cherokee.org
Chestnut Hill Hospital
Philadelphia, PA
www.chhealthsystem.com
Children’s Mercy
Hospitals and Clinics
Kansas City, MO
www.childrensmercy.org
Children’s of Alabama -
Respiratory Care Service
Birmingham, AL
www.childrensal.org
Christ Hospital-
Respiratory Department
Jersey City, NJ
www.christhospital.org
Clarinda Regional
Health Center
Clarinda, IA
www.clarindahealth.com
Cleveland Clinic
Cleveland, OH
www.clevelandclinic.org
Community Howard Regional
Health System
Kokomo, IN
www.howardregional.org
Cook Children’s
Medical Center
Fort Worth, TX
www.cookchildrens.org
Craig Hospital
Englewood, CO
www.craighospital.org
Crouse Hospital
Syracuse, NY
www.crouse.org
CSW Medical Corp
Warm Springs, GA
www.centralstatehospital.org
Cuyahoga Community College -
Respiratory Care Program
Parma, OH
www.tri-c.edu
Dekalb Medical Downtown
Decatur LTAC
Decatur, GA
www.dekalbmedical.org
Detroit Medical Center -
Children’s Hospital
of Michigan
Detroit, MI
www.childrensdmc.org
Forrest City Medical Center
Forrest City, AR
www.forrestcitymedicalcenter.com
Frederick Memorial Hospital
Frederick, MD
www.fmh.org
Freeman Health System - West
and East
Joplin, MO
www.freemanhealth.com
Geisinger Health System -
Danville
Danville, PA
www.geisinger.org
HealthSouth City View
Rehabilitation Hospital
Fort Worth, TX
www.healthsouthcityview.com
Hillcrest Hospital
South Tulsa, OK
www.hillcrestsouth.com
Indiana University Health
LaPorte Hospital
LaPorte, IN
www.iuhealth.org
Inova Fairfax Hospital
Falls Church, VA
www.inova.org
Jameson Health System
New Castle, PA
www.jamesonhealth.org
John Peter Smith Hospital
Fort Worth, TX
www.jpshealthnet.org
Kaiser Permanente -
Los Angeles Medical Center
Los Angeles, CA
www.kp.org
Kindred Hospital
Baldwin Park
Baldwin Park, CA
www.khbaldwinpark.com
Klingensmith
HealthCare
Ford City, PA
www.klingshc.com
Leesburg Regional Medical
Center
Leesburg, FL
www.cfhalliance.org
Lehigh Valley
Health Network
Allentown, PA
www.lvhn.org
Lima Memorial Health System -
Respiratory Care Department
Lima, OH
www.limamemorial.org
Longview Regional Medical
Center - Respiratory Therapy
Department
Longview, TX
www.longviewregional.com
Mayo Clinic
Rochester, MN
www.mayoclinic.com
Memorial Hospital of Converse County
Douglas, WY
www.conversehospital.com
Mena Regional Health System
Mena, AR
www.menaregional.com
Mercy Health System
Janesville, WI
www.mercyhealthsystem.org
Mercy Hospital Joplin
Joplin, MO
www.mercy.net/joplin-carthagemo
Methodist Le Bonheur Healthcare
- Methodist Fayette Hospital
Somerville, TN
www.methodisthealth.org
Methodist Manseld Medical
Center
Manseld, TX
www.methodisthealthsystem.org
Millennium Respiratory Services
Whippany, NJ
www.millenniumrespiratory.com
Morristown Medical Center -
Respiratory Care Department
Morristown, NJ
www.atlantichealth.org/morristown
Mount Sinai Medical Center -
Respiratory Therapy Department
Miami Beach, FL
www.msmc.com
BEST
2012
of
See
pg 23
See
pg 25
See
pg 24
Best of 2012 | RT Magazine 19
NOMINEES FOR BEST OF 2012 RESpIRaTORy caRE DEpaRTMENTS
BEST
2012
of
Muhlenberg Community Hospital -
Respiratory Care Services
Greenville, KY
www.mchky.org
Munson Medical Center
Traverse City, MI
www.munsonhealthcare.org
New York-Presbyterian/
Columbia Medical Center
New York, NY
www.nyp.org
North Country Hospital
- Respiratory Care
Cardiopulmonary Services
Newport, VT
www.nchsi.org
North Metro Medical Center
Jacksonville, AR
www.northmetromed.com
North Mississippi Medical Center
Women’s Hospital
Tupelo, MS
www.nmhs.net
Lourdes Hospital
Binghamton, NY
www.lourdes.com
Our Lady of the Lake RMC
Baton Rouge, LA
www.ololrmc.com
Paoli Hospital - Respiratory
Care Department
Paoli, PA
www.mainlinehealth.org/paoli
Peterson Regional Medical
Center
Kerrville, TX
www.petersonrmc.com
Phoenix Children’s Hospital
Phoenix, AZ
www.phoenixchildrens.com
Plaza Medical Center - RT
Department
Fort Worth, TX
www.plazamedicalcenter.com
Presbyterian Healthcare -
Pulmonary Function Lab
Charlotte, NC
www.presbyterian.org
Providence Portland Medical Center
Portland, OR
oregon.providence.org
Ralph H. Johnson
VA Medical Center
Charleston, SC
www.charleston.va.gov
Rapid City Regional Hospital
Rapid City, SD
www.regionalhealth.com
Research Medical Center
Kansas City, MO
www.researchmedicalcenter.com
Robert Wood Johnson University
Hospital - Respiratory Care Services
New Brunswick, NJ
www.rwjuh.edu
Roosevelt Warm Springs
Warm Springs, GA
www.rooseveltrehab.org
Roseland Community Hospital -
Cardio Pulmonary Department
Chicago, IL
www.roselandhospital.org
Rutherford Regional
Health System
Rutherfordton, NC
www.rutherfordhosp.org
Saint Vincent Charity Medical Center
Cleveland, OH
www.stvincentcharity.com
Saline Memorial Hospital
Benton, AR
www.salinememorial.org
Sanford Medical Center Fargo
Fargo, ND
www.sanfordhealth.org
Santa Clara Valley Medical
Center - Respiratory Care
Department
San Jose, CA
www.scvmc.org
Select Specialty Hospital -
Longview
Longview, TX
www.selectspecialtyhospitals.com
Select Specialty Hospital -
Nashville
Nashville, TN
www.selectspecialtyhospitals.com
Shands Hospital - Respiratory
Care Department
Gainesville, FL
www.shands.org
South Miami Hospital
South Miami, FL
www.baptisthealth.net
South Pointe Hospital -
Respiratory Care Services
Warrensville Heights, OH
my.clevelandclinic.org
Southeast Louisiana Veterans
Health Care System -
VA Medical Center
New Orleans, LA
www.neworleans.va.gov
Sparrow Ionia Hospital
Ionia, MI
www.sparrow.org
St John Macomb - Oakland
Hospital / Macomb Center
Warren, MI
www.stjohnprovidence.org
St. Luke’s Baptist Hospital -
Department of Respiratory Care
San Antonio, TX
www.baptisthealthsystem.com
St Luke’s Hospital
Chestereld, MO
www.stlukes-stl.com
St. Mary’s Health Care System
Athens, GA
www.stmarysathens.org
St Mary’s Medical Center -
Respiratory Care Department
Blue Springs, MO
www.stmaryskc.com
Sutter Auburn Faith Hospital
Auburn, CA
www.sutterauburnfaith.org
Sutter Roseville Medical Center
Roseville, CA
www.sutterroseville.org
Texas Health Harris Methodist
Hospital Fort Worth
Fort Worth, TX
www.texashealth.org
The University of Arizona Medical
Center - University Campus
Tucson, AZ
www.azumc.com
Thomas Hospital - Respiratory
Therapy Department
Fairhope, AL
www.thomashospital.com
Thomas Jefferson University
Hospital
Philadelphia, PA
www.jeffersonhospital.org
Tift Regional Medical Center
Tifton, GA
www.tiftregional.com
Trinity Health System
Steubenville, OH
www.trinityhealth.com
UAB Hospital Birmingham
Birmingham, AL
www.uabmedicine.org
UC San Diego
Medical Center -
Department of
Respiratory Care
San Diego, CA
www.respcare.ucsd.edu
Union Hospital -
Respiratory Department
Terre Haute, IN
www.uhhg.org
Unity Hospital
Fridley, MN
www.allinahealth.org
University of Miami Hospital
Miami, FL
www.umiamihospital.com
University of New Mexico
Hospital
Albuquerque, NM
hospitals.unm.edu
VA New Jersey
Health Care System
East Orange, NJ
www.newjersey.va.gov
Valley Nursing
and Rehabilitation Center
Taylorsville, NC
www.valleyrehab.com
Wesley Medical Center
Hattiesburg, MS
www.wesley.com
West Georgia Medical Center
LaGrange, GA
www.wghealth.org
Wheaton Franciscan
Healthcare - All Saints
Racine, WI
www.mywheaton.org
See
pg 26
See
pg 20
See
pg 27
20 RT Magazine | Best of 2012
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CARE DEPARTMENTS
CARE DEPARTMENTS
CARE DEPARTMENTS
CARE DEPARTMENTS
RESPIRATORY
RESPIRATORY
RESPIRATORY
RESPIRATORY
Protocol-driven practice together with state-of-
the-art equipment and passionate, dedicated
staff prove to be a winning combination for
both patients and the hospital.
When he was a student, respiratory care prac-
titioner Long Nguyen completed a semester-
long residency at Santa Clara Valley Medical
Center (SCVMC) in San Jose, Calif, and knew
immediately he had found his number one
choice for employment. The growth opportu-
nities, thorough, ongoing training, and—most
of all—the people convinced him that this
hospital was the best place to work.
SCVMC, a 524-bed public teaching hos-
pital, is one of the largest medical centers
in Northern California. The facility runs its
own residency program and also partners
with a program out of Stanford University.
The hospital serves as the hub of emergency
medical services in this part of the state, and
its patient population includes nearly 75%
medically indigent adults.
SCVMC provides a range of services, includ-
ing inpatient, outpatient, and acute care and
comprises six adult intensive care units and a
neonatal intensive care unit; a burn center; a
rehabilitation trauma unit; and a spinal cord
unit. One of the hallmarks of the hospital is
its close collaborative relationship with its
respiratory care department, which plays an
integral role in managing and maintaining the
health of all its patients.
Craig Ivie, RCP, manager of the depart-
ment, started working at SCVMC in 1991
and assumed his current position in 2004. He
reports that the respiratory therapy depart-
ment includes close to 90 therapists who
perform, on average, 800 procedures every
day within every area of the hospital. The
department’s positive impact on patient care
throughout the facility—particularly in the
ICUs—can be attributed to several protocols,
the first of which was developed and imple-
mented in 1994.
PROTOCOLS BENEFIT PATIENTS AND
STAFF
According to Ivie, 90% of the department’s
work—from ventilator management and oxy-
genation therapy to specific intrapulmonary
percussive ventilation (IPV) and bronchodila-
tor treatment—is protocol driven. “This puts
respiratory therapy in the middle of the mul-
tidisciplinary team in the ICUs. We round with
the team and provide input. These protocols
have improved communication between team
members,” he says.
The first protocols, which were written over
a 2-day period by a group of 17 respiratory
care therapists, were implemented in the
medical intensive care unit (MICU) and surgical
intensive care unit (SICU). “We figured out
where the care should go. We went through
the approval process and took changes from
the physicians. There are so many disciplines,
and we had to develop protocols accepted by
all areas. Our therapists did a great job making
it work,” Ivie says. All protocols have been
developed according to American Association
for Respiratory Care (AARC) effective guide-
lines, based on outcomes. “If the protocols
didn’t benefit the patients, we couldn’t grow
the program in all adult areas,” he adds.
Respiratory care practitioner John Dietrich,
a 19-year veteran of SCVMC who administers
the protocol in the MICU and cardiac intensive
care unit (CICU), says, “The protocol saves
time and moves the patient quicker than a
nonventilator care protocol.”
Within 1 year of implementation, the protocols
BY PHYLLIS HANLON
Protocol Driven
Respiratory therapists Long Nguyen and Connie Park evaluate a critical care neonate in the level III NICU.
Santa Clara Valley Medical Center
were expanded to all units throughout the hos-
pital, except for the neonatal and pediatric units
where a lead pediatric respiratory therapist acts
as a liaison between the nursing staff and the
respiratory therapy department. “We respond
to high-risk deliveries and have a high level of
involvement,” says Ivie. “Because respiratory
therapy works so well with the nurses, our sug-
gestions are readily accepted. Through patient
rounds, we figure out how best to treat.”
Ivie points out that standardizing procedures
has expedited care and improved staff efficiency.
“After the first year, we compared data using the
protocols. We had reduced the length of stay by
2.7 days. Every year since then, we’ve continued
to reduce the lengths of stay. Now we are down
to 3.78 days per patient. A reduced ICU stay
usually means a reduced overall hospital stay,”
he says. “But the biggest impact has been the
increased communication between everyone in
the medical center. The protocols give residents,
nurses, and doctors a guide as to what to do
next to wean the patient from a ventilator.”
The respiratory department is especially
pleased with the outcomes in the spinal cord
unit. “The respiratory therapist has to spend
an hour to an hour and a half doing secretion
management, bronchodilation, ventilation,
T-tube insertion, and monitoring vital capaci-
ties. We do a lot of huddles—multidisciplinary
meetings—looking at total care of the patient,”
says Ivie. “Someone with a fresh injury can
spend between 21 and 28 days in the spinal
cord ICU. We try to get them off the ventilator
or to best case scenario as soon as we can.”
POSITIVE OUTCOMES IN-HOSPITAL
AND AT HOME
While the protocol is achieving its goal of
restoring a spinal cord patient’s normal
breathing pattern as soon as medically pos-
sible, it has proven to have additional ben-
efits. Ivie says, “Getting the ventilator home
care company to take on an indigent patient
[upon discharge] had been challenging. It
could take up to 3 weeks to get approval.
Then we needed to bring in the equipment
and train the family and patient to use it. That
took another week or two. So now we were
up to 5 weeks,” he says.
With the protocol in place, patients begin
using LTV1200 ventilators as soon as they pass
the initial injury phase. Ivie says, “We start the
training and approval process right then. When
the patient is ready to go home, it eliminates 5
extra weeks of being an inpatient. This makes a
big difference in patient satisfaction. Physicians
and staff are also much happier.”
Therapists have the luxury of choosing from
several equipment options, including VDR4
high frequency ventilators for patients with
acute respiratory distress syndrome (ARDS),
which have increased survival rate to home
by as much as 65%. Therapists also use online
IPV for patients with pneumonia, mucus plugs,
and asthma; continuous IPV for aggressive
treatment designed to move patients out of
the ICU within 24 hours; and SenTec monitors
to treat the sickest patients.
“Our therapists are proud of the work
they are doing as a county hospital. We are
fortunate administration allows us to obtain
state-of-the-art equipment. We have a fleet of
60 Servo-i ventilators and 10 GE Carestations
for use in the nursery,” Ivie says. “Our thera-
pists have a wide choice when it comes to
equipment to treat.”
In addition to working in the special units,
respiratory therapists contribute significantly
to care in the emergency room, very often
running three or four ventilators simultane-
ously; administering metered dose inhalers,
small valve nebulizers, and BiPAP; and starting
initial ventilation. Additionally, four respiratory
therapists perform as many as 1,500 studies
annually in the pulmonary function department
and also answer equipment-related questions.
SCVMC participates in a residency program
with Stanford University and also sponsors its
own. Respiratory therapists interact routinely
with residents and attendings at bedside and
during rounds, assisting with training at all
levels and guiding interns as part of their edu-
cation. Ivie says, “We have a dynamic relation-
ship with residents.”
SCVMC has been involved in numerous
studies throughout the years, specifically with
the NICU and spinal cord rehabilitation thera-
pies. Dietrich notes that in the respiratory field
several studies have examined ways to success-
fully ventilate spinal cord patients. This year the
respiratory care department is launching its first
primary study, a lung recruitment trial that will
research more viable ways to treat ARDS. “We
hope to see how we can open lungs, keep them
open, ventilate better, and wean the patient
Best of 2012 | RT Magazine 21
BEST
2012
of
From left, Long T, Steven Tam, and Sue Rodriguez discuss a ventilated spinal cord injury patient in the rehabili-
tation trauma unit.
From left, Craig Ivie teaches John Dietrich, Joanne
McKee, and Donna Nickolopoulos how to use the
VDR4 high frequency ventilator.
22 RT Magazine | Best of 2012
BEST
2012
of
better. By venting more of the lung, we can use
lower pressure, which is better for the lung,”
says Ivie. “We’ll look at oxygenation to reduce
length of stay.” The department’s therapists
plan to measure functional residual capacity
(FRC) and record outcome data, which will help
identify more effective ways to wean patients
off ventilators sooner.
NEW TECHNOLOGY AND ADDED SPACE
INCREASE PRODUCTIVITY
Until 8 years ago, the respiratory therapy
department utilized manual charting, a cum-
bersome, time-consuming, somewhat ineffi-
cient means of tracking procedures, care, and
costs. “We partnered with rehabilitation ser-
vices to purchase the [MediLinks] program from
MediServe Corp in 2004. This purchase has
brought tremendous benefits business wise and
professionally,” says Ivie. “Notes are legible
and concise. We have increased our charge
capture by up to $200,000 a month. This has
helped our overall productivity.”
Therapists use 200 wireless, full-size laptops
on movable carts that can easily travel from
one unit to another. Ivie notes that the county
recently signed a contract with software com-
pany Epic and the entire medical facility will be
fully integrated by May 2013.
In spring 2014, the respiratory care depart-
ment will be on the move—to a new build-
ing on campus. The new structure will add
200 beds and 32 ICU beds to the existing
ones at SCVMC. Respiratory care will occupy
a larger space with 1,000 square feet for
storing equipment. “The main report area
will seat 48 staff members. There will be a
locker/break room and computer workstations
with AV equipment for educational in-service
programs,” says Ivie. “We’ll have piped-in air
and O2 as well as 60 vents.” He explains that
the department uses more than 100 vents to
test equipment so this will facilitate the task.
“We can test several at a time and do routine
maintenance.” A small conference room/
library will accommodate 10 to 12 people.
PERKS LEAD TO LONGEVITY AND JOB
SATISFACTION
While most of the therapists at SCVMC are
veterans in the field, recent graduates some-
times join the team. “Hiring someone new
is good because we have an opportunity to
mold that person into the kind of therapist
that works well for the institution,” Ivie says.
“They have to be aggressive, use the skills
they’ve been taught and what they learn here.
We are so protocol driven, the person can’t
fear talking to the doctors. They have to take
the initiative and advocate for the patient.”
Due to the working environment, excel-
lent benefits, and opportunities for growth,
SCVMC has retained many of the same respi-
ratory therapists for several years. “It’s quite
common for staff to stay. We have fabulous
benefits, the pay is okay, and we have a great
retirement/medical package. Because of every-
thing you see and can do, staff gets vested in
the county system. We also enjoy autonomy
that may not be afforded at other hospitals,”
he says, citing a less than 2% turnover rate.
Staff also benefit from the department’s
firm belief in ongoing training and education.
An initial orientation of 6 weeks with more
intense training for specific practice areas
is just the beginning. Throughout the year,
the department sponsors between eight and
12 lectures that offer CEUs. “For instance, a
pulmonologist might come in to give a chest
x-ray interpretation refresher,” Ivie says. He
has been involved with the California Society
for Respiratory Care (CSRC) in the greater Bay
region and notes that the department encour-
ages participation in conferences and classes
and provides tuition reimbursement and leave
to attend the session.
Ask Dietrich why he’s remained at SCVMC
for nearly 20 years and he’ll immediately
respond, “It’s the people I work with. Most of
them have been here for 10 years or more. It’s
like a family.” He adds that the opportunity to
work in several different areas within the hos-
pital keeps the job fresh and exciting. “You’re
not pegged to one role. You can grow and do
what you want,” he says. “Job satisfaction
in this department is high. Several therapists
have been here for 20+ years.”
Nguyen, a relative newcomer with 3 years
under his belt, agrees completely. He has had
the opportunity to work in rehabilitation, the
burn unit, the ICU, med/surg, and the NICU
and says he enjoys the challenge that each
different area poses. “We see some interest-
ing cases. We are encouraged to think about
how we can solve a problem,” he says.
Nguyen plans to stay at SCVMC for the long
haul and looks forward to learning more and
growing professionally. “I’m still green, but the
other therapists are helping me learn the ropes,”
he says. “They’ve made me feel very welcome.”
Phyllis Hanlon is a contributing writer for
RT
.
For further information, contact RTeditor@
allied360.com.
Santa Clara Valley Medical Center
751 S Bascom Ave
San Jose, CA 95128
408-885-5000
www.scvmc.org
The respiratory care team at Santa Clara Valley Medical Center.
Children’s of Alabama has provided specialized
medical care for ill and injured children across the
state and throughout the southeastern United States
since 1911. It is the only hospital in Alabama dedi-
cated solely to the care and treatment of children. It
is home to Alabama’s only pediatric trauma center
and the only pediatric burn center in the Southeast.
Children’s of Alabama is one of the 10 busiest pedi-
atric hospitals in the nation with more than 634,000
outpatient and nearly 14,000 inpatient visits in 2011.
Outpatient care is provided through primary care
offices and outpatient centers throughout Alabama.
Ten divisions within Children’s of Alabama
were recently ranked among the best children’s
hospital programs in the nation by
US News &
World Report
. These included pulmonology, neu-
rology and neurosurgery, orthopedics, urology,
neonatology, cancer, cardiology, gastroenterology,
endocrinology, and nephrology.
A 750,000-square-foot expansion facility, The
Benjamin Russell Hospital for Children, opened August
4, 2012. The additional space expanded Children’s
from a total of 275 patient beds to 332 patient beds
plus 48 neonatal intensive care unit bassinets. With
the expansion, the hospital plans to add two new
services—pediatric transplant and pediatric cardi-
ology—which will make it the only comprehensive
pediatric health care facility in the state.
RESPIRATORY CARE AT CHILDREN’S
OF ALABAMA
Respiratory therapists at Children’s of Alabama
practice in an environment conducive to learning
and professional growth. They work with other
health care professionals committed to providing
family-centered care to patients in a variety of set-
tings. Realistic staffing ratios and a supportive team
environment help to ensure that each patient is
treated safely and effectively.
Currently, more than 120 respiratory therapists
are available on staff to ensure that each patient
receives the highest quality care. One department
manager oversees the day-to-day operations of the
acute and chronic care areas. Another oversees the
day-to-day operations of the critical care areas. A
dedicated staff of respiratory therapists is regularly
assigned to work in each area with the goal of
enhancing the consistency of patient care.
Practicing in the acute and chronic care areas
of the hospital affords respiratory therapists the
opportunity to develop and expand essential skills
while caring for patients of all ages and treatment
needs. Acute care respiratory therapists played an
integral role in the development and implementa-
tion of the inpatient asthma care pathway utilized
at Children’s of Alabama. Since initial implementa-
tion in April 2011, use of the pathway has been
associated with decreased length of stay and a
reduction of hospital charges for these patients.
When compared to patients receiving usual care,
pathway patients have a 50% reduction in length of
stay and a 33% reduction in charges per admission.
Additionally, respiratory therapists have contributed
greatly to the development of a standardized inpa-
tient asthma education class for patients and their
families. Acute care respiratory therapists play vital
roles in caring for children admitted to the Home
Ventilator Program and are also valued members of
a nationally recognized cystic fibrosis center.
Included within critical care areas at Children’s
of Alabama are a 22-bed pediatric ICU, a 20-bed
cardiovascular ICU, a 48-bed neonatal ICU, and a
6-bed regional burn center. Critical care respira-
tory therapists function as integral members of the
patient care team, working closely with physicians
and nurses to provide care following the most
current medical practices and utilizing the latest
technologies.
THE MISSION
The mission of Children’s of Alabama is to provide
the finest pediatric health services to all children in
an environment that fosters excellence in research
and medical education. Children’s of Alabama
respiratory therapists work to support the mission
by being advocates for all children and by partici-
pating in community outreach programs to educate
the public about issues affecting children’s health
and well-being. Children’s of Alabama respiratory
therapists share a passion for working with children
and a dedication to realize the vision of providing a
better childhood for all children.
Written in collaboration with the editors of
RT
Magazine.
Best of 2012 | RT Magazine 23
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Children’s of Alabama
Respiratory therapists at Children’s of Alabama find themselves working in one of the 10 busiest pediatric hos-
pitals in the nation.
Children’s of Alabama
1600 7th Ave South
Birmingham, AL 35233
205-939-9100
www.childrensal.org
Respiratory therapists at Children’s of
Alabama work to provide a better childhood
for all children.
BY ROBERT W. PARK, BS, RRT
Supporting the Mission
The best RT departments are not always found
in large metropolitan hospitals. Some of the best
departments can be found in small community
or rural hospitals. Such is the case with the RT
departments at Roosevelt Warm Springs Institute
and Central State Hospital. Both departments
are managed and staffed by CSW Medical Corp,
a small corporation owned and operated by two
respiratory therapists, Alex and Beverly Saint-
Amand. CSW Medical was envisioned in the mid
1980s when the need for high-quality health
care in the rural setting was identified. Initially
focusing on the care of patients in their home,
CSW expanded its corporate philosophy into
the hospital setting. With clinical backgrounds
in nursing, cardiology, and ultrasound, as well
as respiratory therapy, CSW established multi-
dimensional hospital RT departments that offer
a wide array of services above and beyond the
routine RT department. This has been benefi-
cial for CSW’s partner hospitals as they team to
provide top quality respiratory therapists who
are cross trained to cover essential services not
offered elsewhere in the hospital.
For almost 50 years, Roosevelt Warm Springs
(RWS) has provided quality rehabilitation care
beginning with Franklin Delano Roosevelt’s
founding treatment for polio. Its long tradition
of rehabilitation for polio patients continued with
two hospitals and outpatient services. Inpatients
are served in either the long-term acute care
hospital (LTACH) or the inpatient rehabilitation
hospital (IRF). CSW Medical manages and staffs
the RT department at RWS with registered respi-
ratory therapists who have the personality and
experience to work with some of the most difficult
cases. They interact with all hospital disciplines,
the patients, and their families to effect the best
outcomes. They are cross-trained for vascular
and cardiac ultrasound and provide point of care
laboratory testing and phlebotomy services. In
2010, the RWS LTACH began accepting long-
term ventilator patients for ventilator care and
weaning. With the program still in its infancy, its
success rate has exceeded 80%, outperforming
many of the larger vent weaning units. With both
an LTACH and IRF on the premises, RWS is able to
progress patients from the LTACH, to the IRF, and
then to home. This makes a seamless transition
for the patients and their families.
Beverly states, “Our respiratory therapists
want to see the best outcomes for our patients.
They routinely attend team conferences and
interact daily with physical therapy, occupational
therapy, speech, nursing, case management, and
physicians to see that our patients are getting
the best care. We have developed protocols
that allow us to progress patients forward with
their therapy without having to wait for physi-
cian intervention. We earned the respect of our
professional medical staff, and they support our
decision making wholly.”
Central State Hospital (CSH) provides skilled
and intermediate nursing home care for clients
with significant medical and nursing needs in
addition to mental illness or developmental
disabilities. It takes unique and dedicated RTs
to work in this environment of care. Often
abandoned by their families, these patients will
break your heart every day. CSW’s respiratory
therapists meet this challenge head on. RT at
CSH is the “go to” department. They provide
daily rounds on patients, identifying those who
are at risk for aspiration pneumonia, and have
implemented treatment protocols to prevent
acute hospital admissions. With a high popu-
lation of tracheostomized patients, they work
closely with the nursing department and physi-
cians to ensure the safety of their patients. In
addition to routine and specialized RT services,
CSH’s RT department also performs EEG testing
on its many neurologically impaired patients,
ensuring they receive appropriate treatment for
their disorder. Without RT to provide this vital
service, many of these patients would have to be
transferred to outside facilities.
Often asked how they have managed to survive
almost 30 years of working together, Alex and
Beverly insist they can’t imagine anything differ-
ent. “It’s not work when you love what you do.”
And it helps that we have the best RTs!
Written in collaboration with the editors of
RT
Magazine.
24 RT Magazine | Best of 2012
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CSW Medical Corp
Alex and Beverly Saint-Amand use their respiratory therapy background to fill the need for high-quality health
care in rural areas.
The AARC’s 2011 Long Term Care Specialty
Practitioner of the Year and his wife
describe how they teamed top respiratory
therapists to bring the best in RT services
to rural hospitals in Georgia.
BY ALEX SAINT-AMAND, MBA, RRT, AND BEVERLY
SAINT-AMAND, BA, RN, RRT
CSW Medical Corporation’s
RTs Are Among the Best
CSW Medical Corp
PO Box 541
Warm Springs, GA 31830
706-655-5351
www.centralstatehospital.org
Morristown Medical Center, part of Atlantic Health,
has been recognized by Castle Connolly Medical Ltd,
publishers of America’s Top Doctors, as the best hos-
pital in New Jersey 2 years in a row. The respiratory
care department at the medical center promotes a
healthy work environment, skilled communication,
true collaboration, effective decision-making, appro-
priate staffing, meaningful recognition, quality lead-
ership, supportive medical direction, and, finally, a
passion to lead. All of these factors work together to
result in superior patient care delivered with respect,
dignity, compassion, and pride.
Our therapists support local, regional, and national
efforts to promote the advancement and involve-
ment of the respiratory care profession, including
participation in community health fairs and spirometry
screenings, and planning regional and national cystic
fibrosis (CF) conferences. Among its many innovative
programs, the respiratory care department is particu-
larly proud of its “unit-based teams” model of care,
designed to improve clinical expertise, improve con-
tinuity and consistency of care, and improve patient
outcomes and education. A lead therapist heads each
of the seven teams and all team members must be
proficient (via competencies) in the requirements of
the hospital unit they serve. We have found that the
unit-based team concept not only accomplishes the
goals it was designed to achieve, but it also provides
a better allocation of resources, improves communica-
tion with physicians and nurses, and improves the
satisfaction level of the respiratory care staff.
The department also has developed the
Respiratory Therapist Professional Advancement
Career Track (RT PACT) program to empower and
recognize therapists who choose to further grow
and develop professionally. Therapists are given the
option to pursue the development of professional,
clinical, educational, and leadership skills to enhance
their own careers, as well as promote the profession
and the image of respiratory as a whole.
The respiratory care department uses a shared
governance model for self-leadership, which
increases employee satisfaction. From the practice
council, which approves and recommends activities
that affect the staff’s daily work, to the professional
development council, which helps identify and
support the staff and their educational needs, the
goal is to develop and support the entire respiratory
staff in their work.
The department is an integral part of the Atlantic
Health Accountable Care Organization (ACO)—
formed to improve patient care quality, reduce
costs, and streamline health care delivery—and
offers expertise in the areas of chronic obstructive
pulmonary disease (COPD), congestive heart failure,
and pneumonia. In developing the Atlantic Health
ACO, the leadership at Morristown felt that it was
important to have the clinical expertise of a respira-
tory care practitioner on the Pulmonary Workgroup
Committee. I have the privilege of serving not only
as a participatory member, but as a team leader for
the workgroup. In addition, the department actively
supports the Atlantic Health Pulmonary Center of
Excellence, which provides comprehensive, state-
of-the-art pulmonary services to adult and pediatric
patients for a range of conditions, including lung
cancer, sleep disorders, CF, and COPD.
During these changing times in health care, par-
ticipation in evidence-based research to guide our
clinical practices and in hospital research to further
advance the practice of respiratory care gives two
examples of how we evolve our roles and model of
care delivery. We have presented an abstract to the
American Association for Respiratory Care demon-
strating the effectiveness of using home spirometers
to identify early exacerbation in CF, and are actively
involved in other CF research efforts. For example,
the airway clearance technique, manual oscillatory
positive expiratory pressure (MOPEP), was developed
and tested at Morristown and is now used at many
CF centers around the country. Research performed
by respiratory care practitioners at Morristown also
is being considered for a multi-center, blinded study
at CF centers in the Mid-Atlantic region. Our leader-
ship team, consisting of clinical coordinators, lead
therapists, charge therapists, and shared governance
council chairs, guides and supports our staff to reach
their full potential.
I am proud of the many accomplishments and
awards earned by our staff, and I am privileged to
work with such a leading, innovative team of highly
skilled, compassionate professionals.
Written in collaboration with the editors of
RT
Magazine.
Best of 2012 | RT Magazine 25
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Morristown Medical Center
The respiratory care staff at Morristown Medical Center strives to provide superior patient care and advance the
profession.
Morristown Medical Center
100 Madison Ave
Morristown, NJ 07960
973-971-5000
www.atlantichealth.org/morristown
The hospital has been ranked among the top
50 hospitals by
US News and World Report
.
BY BEVERLY NATALE, MAS, RRT
A Passion to Lead
26 RT Magazine | Best of 2012
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In only 3 years, Paoli Hospital, a member of The
Main Line Health System, has metamorphosed from
a medium-sized suburban community hospital—the
“little hospital up on the hill”—to a level two trau-
ma center serving Philadelphia’s Chester County. The
transformation drastically increased the workload
facing the respiratory therapists at Paoli, but they
have more than risen to the challenge and now focus
on better improving patient care and outcomes.
Paoli—one of only 50 hospitals in the nation to
take part in the Pebble Project, a joint research effort
with The Center for Health Care Design to apply evi-
dence-based “best practices” to the design of health
care facilities—opened a new 500,000-square-foot
patient care pavilion in 2009, almost doubling the
size of the hospital, and increasing the number
of licensed beds from 157 to 214. The expansion
required Karen Kofalt, MS, RRT, director of respira-
tory care, pulmonary diagnostics, and cardiac reha-
bilitation, to grow the respiratory care department
to meet the new needs, bringing the number of
full-time equivalent (FTE) respiratory therapists to 15,
or approximately 23 employees.
This staff serves both the respiratory care and pul-
monary diagnostic departments, yet they don’t work
in a vacuum. Patients receive care from an integrated
team of registered respiratory therapists, registered
nurses, and physicians. This team approach, and a
close relationship with the nursing staff in particular,
allows the respiratory care department to focus its
efforts on critical care patients in the intensive care
unit and emergency department. The nursing staff in
turn does much of the respiratory floor care, with the
respiratory care staff serving as consultants available
to do reevaluations as needed.
“The relationship with nursing is very strong and
I think extremely essential to the respiratory staff
providing the quality care they need to at the bed-
side,” says Kofalt.
This integrated approach allows the respiratory
therapists to also staff the hospital’s state-of-the-
art pulmonary diagnostic department, featuring a
diagnostic lab, pulmonary rehabilitation program,
and maintenance program. The department—
the third in the country to have its outpatient
chronic obstructive pulmonary disease (COPD) pro-
gram certified by the Joint Commission Disease
Certification—identifies patients with lung issues
who are then referred to the rehab program by a
physician. The 12-week program provides patients
with twice weekly education and exercise training
sessions. Once they graduate, rehab patients are
encouraged to join the department’s self-pay main-
tenance program. Unlike a local gym, the mainte-
nance program provides patients with supervision
and monitoring, including blood pressure and blood
saturation, and also allows them to work out with
others like themselves. Three respiratory therapists
and five exercise physiologists staff the pulmonary
diagnostic department, and as Kofalt says, “They
do an amazing job. They are the brains behind the
success of our COPD disease certification.”
The same skill and dedication that went into cre-
ating a successful COPD program found its way into
the staff’s efforts to reduce patient ventilator days
and cases of ventilator associated pneumonia (VAP).
Paoli averages about 1,800 ventilator days annually
and has an “extremely low” VAP rate, according to
Kofalt—a trend the department strives to maintain.
“Obviously, decreasing infection between patients
and preventing VAP are extremely important to us as
we move toward the era of value based purchasing
where hospitals won’t necessarily get reimbursed for
hospital acquired infections. So we strive to maintain
a safe environment for our patients and staff. Our
focus and education supports our commitment to
preventing hospital acquired infections,” she says.
Another department priority has been to decrease
noninvasive ventilation and the number of patients
intubated and put on ventilators. The use of high
flow nasal cannulas is instrumental in this effort.
“We’re using a lot of high flow nasal cannulas
and we’re noticing that our noninvasive days are
really decreasing. It’s also preventing patients from
being transferred to a higher level of care,” says
Kofalt. “Right now, we’re in the process of formulat-
ing a few case studies to show to our doctors how
successful we are with this tool. It’s something that
we’re very excited about, and it’s going very well.”
The success of Paoli’s respiratory care staff is
clear. It has thrived amidst rapid growth, and all the
while maintained a commitment to quality patient
care and improved patient outcomes. As Kofalt says,
“I’m extremely proud of the care we give and the
staff’s commitment to patient outcomes.”
Alison Werner is associate editor for
RT
.
For further information, contact RTeditor@
allied360.com.
The respiratory care staff at Paoli Hospital is charged with serving both the respiratory care and pulmonary
diagnostic departments.
As the hospital grows, Paoli Hospital’s respi-
ratory therapists work to transform patient
care and outcomes.
BY ALISON WERNER
Growing and Thriving
Paoli Hospital
255 W Lancaster Ave
Paoli, PA 19301
484-565-1000
www.mainlinehealth.org/paoli
Paoli Hospital
Best of 2012 | RT Magazine 27
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Nestled within the small college town of
Gainesville, Fla, sits Shands Hospital, a world-
class medical facility whose respiratory care
practitioners play a key role in patient care.
The positive influence of its respiratory team is
apparent throughout every department in this
teaching/research institution.
According to Tracy R. Holden, MBA, RRT, RCP,
director of cardiopulmonary and neurodiagnostic
services, business as usual involves access to
top-of-the-line equipment and fully computerized
charting. “We have computers on wheels for
staff so they can do procedures at the bedside,
like blood gas testing and measuring electro-
lytes,” she says. The department comprises 160
full-time respiratory care practitioners.
Several ongoing educational and training
opportunities help keep staff up-to-date on
the most current research, techniques, and
equipment in the field. “Two educational
coordinators provide training at three different
in-house conferences every year,” says Holden,
adding that Harvard University also conducts a
6-month project management course on-site.
The administration encourages staff to attend
state and national conventions as well.
Moreover, both the hospital and the depart-
ment have joined the national movement
toward 4-year degrees for respiratory care
therapists. Holden notes that the hospital’s
affiliations with the University of Florida, as
well as its own teaching facilities, facilitate
obtaining a degree.
RESEARCH OPPORTUNITIES ENRICH
THE WORK
Respiratory therapists at Shands have a unique
opportunity to become involved in several
research initiatives. For instance, Holden reports
that the medical director, Michael A. Jantz, MD,
who is ranked #2 nationally in his field, has done
significant research on bronchial thermoplasty.
Severe asthmatics who are not maintained on
medications, but whose lives are controlled by
their illness, have shown positive outcomes,
Holden explains. “After 6 years of study, they
have little to no asthma issues. Fewer than 10
centers do this,” she adds.
Additionally, therapists have worked with
David W. Kays, MD, who specializes in diaphrag-
matic hernias, and has used extracorporeal mem-
brane oxygenation (ECMO) extensively to help
many patients survive what used to be a terminal
diagnosis. An accredited Center of Excellence in
ECMO, Shands received an Award for Excellence
in Life Support for its ECMO program.
TEAMWORK ENHANCES WORK AND
PLAY
While equipment, education, and research
opportunities enhance their jobs, staff unani-
mously agree that the people make the big-
gest difference at Shands. The scope of expe-
rience—time on the job ranges from 2 to 20
years—offers a balance of fresh, new ideas and
proficiency. Holden looks for academically qual-
ified individuals who have integrity and a good
outlook on patient care, and will advocate for
them, and who demonstrate teamwork. “To fit
in, they have to be dedicated, have energy and
a positive attitude,” she says.
In the last 3 years, the respiratory care
department has created 49 new positions. One
of the ways in which the department fills those
slots is through its residency program, which
instills confidence and enhances self-esteem.
“We offer a 2- to 5-week preceptorship where
students learn the job,” says respiratory prac-
titioner Tom Selig. “The students come in and
see how we function. They get to know the
doctors and evaluate the hospital, and the
department gets a 5-week job interview.”
Not only does the respiratory care staff
collaborate during work hours, but they also
extend their camaraderie outside the hospital.
All staff is invited to—and a majority partici-
pate in—several activities from holiday parties
and golf outings to camping trips and tubing at
one of the 40 natural springs in the area. Selig
says, “These activities bolster teamwork.”
Practitioner Leonile Kicnurse attributes the
cohesiveness and progress in the department
to Holden. “We are going in the right direction
due to our director’s vision and leadership. She
supports us and allows us to grow,” she says.
Holden, in turn, credits her staff for its dedi-
cation. “We want the best of the best, people
who are committed to the excellence of the
team. Our goal is not to be one of the best, but
to be the best in the nation.”
Phyllis Hanlon is a contributing writer for
RT
.
For further information, contact RTeditor@
allied360.com.
Shands Hospital
Shands Hospital
1600 SW Archer Rd
Gainesville, FL 32608
352-265-0078
www.shands.org
The respiratory team at Shands Hospital takes
advantage of a world-class facility and unique
opportunities to enrich patient care.
BY PHYLLIS HANLON
Enriching Care
In the last 3 years, the respiratory care department at Shands Hospital has expanded, adding 49 new positions.

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