Permanent Respiratory Therapists

Respiratory Therapy Belongs in the ER, ClaimsVernon Pertelle

Health care management professionalVernon Pertelleis advocating for the permanent placement of respiratory health professionals in hospitals and urgent care facilities. This advocacy comes on the heels of KentuckyOne Health’srecent cuts of respiratory therapists from emergency rooms at three major Kentucky medical facilities during a recent bout of layoffs.

According to BizJournals.com, all three medical facilities under KentuckyOne in the Louisville area – Jewish Medical Centers East, South, and Southwest – will have the respiratory therapists working in their emergency departments eliminated. Nurses with “refresher training” will take over the respiratory care needs of ER patients.

KentuckyOne also operates St. Joseph Hospital in Lexington and the University of Louisville Hospital in addition to the Jewish Hospital. Over the weeks leading into March, they have laid off approximately 500 workers.

Why KentuckyOne Made a Mistake

As reporter Chris Otts reported for the Louisville news radio station WDRB, even though providing respiratory care services is within the legal scope of nursing practice in Kentucky, many facility employees are worried that these “refreshed” nurses do not have the right level of training or experience to do the respiratory therapists’ jobs optimally. Vernon Pertelle agrees.

“Respiratory therapists (RTs) are allied health professionals with specialized and specific content area expertise regarding the care and treatment of patients diagnosed with respiratory disease,” explains Pertelle.“It’s difficult to understand why the decision was made to eliminate the role of the RT in the emergency room given the fact that CMS’ readmission reduction program plans to expand the applicable conditions for FY 2015 to include patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD).”

One anonymous respiratory therapist whose job was being eliminated in the cuts told WDRB that, legal scope or not, the nurses replacing them do not have any education or experience in respiratory care functions, such as ventilator operation and management, whatsoever. “This is not a game,” the RT said. “If you do something wrong, you can kill a person.”

Meanwhile, an anonymous nurse within one of KentuckyOne’s facilities told the news station that this move by the system is “dangerous for the nurse and the people in the community… They are definitely not giving us enough education.”

How a Bad Decision Was Made

Vernon Pertelle says that he realizes how the decision could have been made, as health systems often face financial challenges and must make difficult decisions as a result, including, unfortunately, the occasional layoff. KentuckyOne was one such system facing such financial problems when they made their decision to lay off 500 or so employees. The system even issued a statement claiming, “Eliminating positions is especially hard,” but that “these decisions are necessary to help reverse the system’s financial losses and operate more efficiently.”

“However,” says Pertelle,“the challenges with treating and managing the patients with respiratory illness that end up in the emergency room will be compounded by the fact that nurses, by and large, do not have the established competencies to manage patients on complex respiratory equipment.  Most importantly, while respiratory care is within their scope of practice, many lack the skills and knowledge to effectively perform the care to ensure positive health outcomes.”

Janet Vogt, the director of clinical education at Bellarmine University’s respiratory therapy program, told WDRB that a typical respiratory degree program includes “over 500 hours of didactic, lab and clinical experience on mechanical ventilation alone,” with degree programs lasting between two and four years. Given this extensive training requirement to become a certified respiratory therapist, concerns about replacing these highly-skilled professionals with complete novices, however skilled they may be in other areas of health care, are understandable.

What Comes Next

This layoff of respiratory therapists could very easily come back to harm the hospitals and their patients as much or more than the laid off RTs themselves. As Vernon Pertelle explains, “What will potentially occur is a reduction in throughput and a potential increase of LWOTs (Leave without Treatment) due to the delays that will occur as a result of the increased workload and learning curves as nurses try to get up to speed to take on the role of the respiratory therapist.”

What would have made much more sense, says Pertelle,would have been to cross train the respiratory therapists in non-clinical/non-traditional roles in order to increase efficiencies while ensuring that a very valuable resource is still available for long-term positive patient outcomes. This strategy also would have come with potential financial rewards that would have helped to improve the bottom line of the organization by preventing readmissions through the use of respiratory therapists. 

“RTs are a valuable resource,” says Vernon Pertelle,“not only in the emergency room but also in non-traditional roles within the organization, such as physician extenders (office-based clinics) or Patient Centered Medical Homes (PCMHs), to improve patient education and empower them with self-management of their disease.They also perform frequent monitoring to mitigate the need for the patient having to go to the emergency room.”

In short, respiratory therapists are a vital asset to any emergency room or urgent care facility. “The backlash in these recent layoffs are just one more reason why RTs need help in becoming mainstays in hospitals and health care facilities,” says Vernon Pertelle.