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4 Best Practices To Make Your Staffing Budget Foolproof

4 Best Practices to Make Your Staffing Budget Foolproof

The almost daily pressure to maintain or even lower staffing levels while also ensuring that patients are receiving safe, value based respiratory care is commonplace for today’s respiratory care manager.

Here are 4 best practices that will help determine the right amount of staff you need:

1. Count the Minutes

Procedures and work units are unreliable measures when measuring respiratory workload.  A vent is not a neb is not a cannula.  A minute value corresponding to the amount of time required to complete the modality task is universally considered best practice.  Counting minutes of therapy renders an accurate and comprehensive measure of total work.

2. Check the Forecast

Rather than putting one’s finger in the air to check the prevailing winds of daily patient care, forecasting workload based on minutes provides an ironclad snapshot of what needs to get done as a function of time. Many departments use automated systems. However, to achieve a competitive advantage, you will need a system that not only captures minutes of work for each active task but one that dynamically manages the process. For example, your system should link tasks to the related physician order information and alert therapists to order changes as well as to any new order tasks. This is a critical feature that helps ensure timely and quality patient care and ensures that you get real-time workload forecasts for the care you provide.

3. Make the Match

Estimating the workload is only half the battle!  Once workload has been calculated, making the match to workforce is where patient safety and department savings are realized.  And the match is easily made: 1 therapist working a full 8 hour shift provides productive therapy for roughly 420 minutes.  If my workload for the shift estimates to 5040 minutes then I will need a workforce of (5040/420 =) 12 therapist.  Matching minutes of work to minutes of workforce ensures renders your staffing budget foolproof.

4. Repeat

Doing the same failed thing over-and-over again, like counting procedures to determine workload, and expecting different results in common parlance is the definition of insanity.  But repeating proven processes time and time again, like estimating workload based on minutes of work and then matching workload to workforce every shift, is the very definition of success.

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Tomorrow’s Asthma Forecast: How Meteorologists Are Attempting To Predict Thunder Asthma

Tomorrow’s Asthma Forecast: How Meteorologists are Attempting to Predict Thunder Asthma

“Tomorrow’s Forecast: Thunderstorms with a chance of asthma.”  This could be an actual weather report coming to a future newscast near you. Following close on the heels of my recent post “Thunderstruck!” I happened on a report at highlighting new research aimed at understanding the storm conditions most likely to spawn epidemic and even fatal episodes of thunder asthma, such as occurred in Melbourne Australia in late 2016.

Watching the Radar

The storm events known to precipitate thunder asthma fall into the weather category of Mesoscale Convective Systems (MCS).  Briefly, these severe weather events occur when thunderstorms aggregate to form a collection of thunderstorms that act as a system. They typically occur in late spring and mostly at night or early morning.  Per the National Oceanic and Atmospheric Administration MCS’s include three main storm types:

  • Mesoscale convective complex (MCC) – a large, circular, long-lived cluster of showers and thunderstorms identified by satellite that often emerge out of other storm types.
  • Mesoscale convective vortex (MCV) – A low-pressure center within an MCS that pulls winds into a circling pattern, or vortex that can take on a life of its own, lasting hours after the parent MCS has dissipated. An MCV that moves into tropical waters, such as the Gulf of Mexico, can serve as the nucleus for a tropical storm or hurricane.
  • Derecho – is a widespread, long-lived wind storm that is associated with a band of rapidly moving showers or thunderstorms with an associated large area of straight line wind damage. A weather event may be classified as a derecho if the wind damage swath extends more than 240 miles (about 400 kilometers) and includes wind gusts of at least 58 mph (93 km/h) or greater along most of its length.

Diagnosing the Storm

Forecasting thunder asthma involves diagnosing the combined elements of any of these mesoscale convective processes., cites the UGA and Emory University study published in the Journal of Applied Meteorology and Climatology noting this assessment includes “the combination of rainfall, winds and lightning from thunderstorms in conjunction with pollen or mold spores”.  The fateful mixture of these factors may result in weather related asthma events reaching epidemic proportions:

  • Rainfall and high humidity rupture bioaerosols, particularly rye grass pollen grains
  • Thunderstorm electrical activity contributes to further pollen fragmentation
  • Gusty winds can spread pollen granules ahead of the storm

Forecasting Asthma

Cross referencing forecasting models that predict the amalgam and severity of these stormy elements may lead to early warning systems for healthcare agencies and those likely to be affected in the tempest targeted population. The AMS journal study abstract details the forecasting methodology: “The authors investigated the utility of several mesoscale products derived from atmospheric soundings such as downdraft convective available potential energy (DCAPE) and indices

Streamline your department with tools designed for respiratory care

for predicting surface wind gusts such as microburst wind speed potential index (MWPI) and a wind gust index (GUSTEX). These results indicate that DCAPE levels reached “high” to “very high” thresholds for strong downdraft winds in the lead-up to the thunderstorm, and the MWPI and GUSTEX indices accurately predicted the high maximum surface wind observations. This information may be useful for diagnostic and prognostic assessment of epidemic thunderstorm asthma and in providing an early warning to health practitioners, emergency management officials, and residents in affected areas.”

While the methodology is not yet ready for prime-time the research holds promise for asthmatics and non-asthmatics alike in areas where mesoscale convection systems are prevalent, such as the plains states, southeast U.S. and midwest.  The well-loved weatherman Willard Scott who quipped “Everyone complains about the weather, but nobody ever seems to do anything about it” may soon be proven wrong.

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Storm related asthma and what you can do to avoid it

In late 2016 thousands of Australians, with no prior history of asthma, found themselves struggling to breath and seeking medical assistance after an outbreak of severe thunderstorms, a few even died.  On November 21st at around 6pm, in Melbourne, “winds and rains from a violent thunderstorm stirred up pollen levels in the air, which led to asthma exacerbations throughout the city.” The phenomenon is known as thunder asthma or thunderstorm-associated asthma (TAA).  A 2002 study concludes that during severe storms “three groups of factors are implicated as causes of TAA: pollutants (aerobiologic or chemical) and meteorological conditions. Aerobiological pollutants include air-borne allergens: pollen and spores of molds. Their asthma-inducing effect is augmented during thunderstorms. Chemical pollutants include greenhouse gases, heavy metals, ozone, nitrogen dioxide, sulfur dioxide, fumes from engines and particulate matter. Their relation to rain-associated asthma is mediated by sulfuric and nitric acid. Outbreaks of non-epidemic asthma are associated with high rainfall, drop in maximum air temperature and pressure, lightning strikes and increased humidity. Thunderstorm can cause all of these and it seems to be related to the onset of asthma epidemic.”  In Melbourne that November day “ryegrass pollen was swept up in whorls of wind and carried from four million hectares of pasturelands (about 9.9 million acres) that lie to Melbourne’s north and west” reported the New York Times , sending 8,500 to the hospital “struggling for breath”.

Streamline your department with tools designed for respiratory care

This is certainly an extreme example, but Spring has sprung bringing the potential for strong storms and rain showers.  It is expedient we understand weather related asthma triggers and providing strategies for ourselves and our patients.  The following approach was adapted from

If you suspect weather is playing a role in your asthma, keep a diary of asthma symptoms and possible triggers and discuss them with your doctor.

Once you know what kind of weather triggers asthma symptoms, try these tips to protect your yourself:

  • Watch the forecast for pollen and mold counts as well as other conditions (extreme cold or heat) that might affect your asthma.
  • Limit your outdoor activities on peak trigger days.
  • Make sure you wear a scarf over your mouth and nose outside during very cold weather.
  • Keep windows closed at night to keep pollens and molds out. If it’s hot, use air conditioning, which cleans, cools, and dries the air.
  • Stay indoors early in the morning (before 10 AM) when pollen is at its highest levels.
  • Avoid mowing the lawn or raking leaves, and stay away from freshly cut grass and leaf piles.
  • Dry clothes in the dryer (hanging clothes or sheets to dry can allow mold or pollen to collect on them).
  • Make sure you always have your quick-relief medicine (also called rescue or fast-acting medicine) on hand.

Your written asthma action plan should list weather triggers and ways to manage them, including any seasonal increases in medication. If your asthma seems to be allergy-related you may also need to see an allergist for medication or allergy shots.

As the springtime adage goes; “April showers bring May flowers”.  If you have asthma or even if you don’t, both showers and flowers can leave you thunderstruck; gasping for your next breath!

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Don’t Take Two Aspirin! (You may not be alive to call in the morning.)

What do asthma, acute rhinitis, and aspirin sensitivity all have in common?  Together they are known as Samter’s Triad.  Max Samter, M.D., F.A.C.P.; and Ray F. Beers Jr., M.D. published their findings linking aspirin sensitivity to an allergic type response and asthma in 1968.  The summary of their findings includes the following, “Angioedema and rhinitis, nasal polyposis, and bronchial asthma of aspirin-sensitive patients are acquired diseases that develop, as a rule, after middle age in predominantly nonatopic (non allergic) patients. In many instances, nasal and bronchial symptoms precede the development of intolerance to aspirin by months or even by years.”1 Since that time much has been discovered.  Samter’s Triad, now known as Aspirin Exacerbated Respiratory Disease (AERD), “is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)” and is estimated to affect “approximately 10% of all adults with asthma”.2  According to Dr. Thomas Chacko, Board Certified Pediatric and Adult Allergist/Immunologist, due to “the lack of research and awareness regarding the condition…nearly 20 percent of cases go undiagnosed.”3 My own AERD is still undiagnosed.  I now have a referral to see an allergist. I had to uncover the cause of my symptoms myself even after multiple visits with several physicians.  I have all three of the classic symptoms in the triad. The thing that really cinches it for me is the headache I had a few years ago that landed me in the ER sucking on the business end of a nebulizer.  More on that story next time.

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