The Mosby’s Medical Dictionary 8th Edition defines evidence-based practice as “the practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical decisions. The term is sometimes used to denote evidence-based medicine specifically but can also include other specialties, such as evidence-based nursing, pharmacy, and dentistry.” In my travels, I see wide ranging variability in the way we ply our common craft, much for which there is no good evidence, especially in the areas of staffing practices, protocol implementation and modality selection.
Modality Selection: Often the decision of which modalities will be provided or prescribed is based on ordering habits or departmental cost rather than clinical trial or the patient-specific disease process. Outdated modalities should be discarded in favor of up-to-date therapies tailored to the patient’s disease state, clinical presentation and clinical outcomes.
Protocol Implementation: The evidence is overwhelming regarding the efficacy and efficiency of therapist-driven protocols. They are proven to boost patient outcomes and patient satisfaction, curb overutilization and decrease cost. A true algorithmic treatment protocol that allows the initiation, modification and cessation of therapies based on specific patient assessment criteria helps respiratory therapists focus their time and leverage their workload as well as increases professionalism and employee satisfaction1 . It is “value added” all the way!
Staffing Practices: A neb is not a vent is not an MDI! Each of these procedures takes a different amount of therapist time to administer or care for. This is why staffing based on billable procedures doesn’t work and typically results in over- or under-staffed conditions. It is comparing apples to oranges. The evidence supports staffing that matches workload to work force based on universally established time standards (Minutes of Work = Minutes of Workforce). So if the total workload minutes for a single eight hour shift is 6,385 based on AARC universal time standards, then the total gross workforce required would equal 13 therapists (6,385 minutes / 480 minutes = 13.3). Granted, this number doesn’t always correlate with the staffing scheduled, but it is a true number–one upon which clinical and business decisions can be based.
We don’t all have to do the same things the same way, but we do have to do the right things the right way. Any evidence to the contrary is not based on the evidence.