Part of an expanding institution, the respiratory services department at Holston Valley Hospital and Medical Center, Kingsport, Tenn, performs an impressive number and variety of procedures. Twelve-hour shifts and a new school of respiratory therapy are unique aspects.
Two major issues that respiratory care managers must deal with are overutilization of services and cost containment. Using the therapy evaluation program detailed here, respiratory personnel assist the physicians in therapy assessment, communicate suggestions to them, and document the patient care plan on a concurrent patient care audit form.
One of the important causes of treatment failure in childhood asthma is poor compliance. The highly structured program to encourage self-help and thus improve compliance described here involves education and behavior modification (patient, parent, and health care team). Children as young as 6 years of age were found to be capable of participating in the program successfully.
In 20 years, this department has grown from a small office with a staff of one to a facility staffed by 44 respiratory therapists and divided into four sections: respiratory therapy, respiratory laboratory, respiratory rehabilitation, and anesthesia. Computer programs complement the department's many services.
The level of air pollution in some homes and offices exceeds the legal outdoor limits. The sources are many, including building materials, furnishings, insulation, gas appliances, cigarette smoking, and fireplaces. Efforts to conserve energy have resulted in the trapping of noxious gases and particulates inside.
To assist hospital committees in maintaining high standards of practice in their facilities, the American College of Physicians has prepared a list of cognitive and procedural objectives which may serve as guidelines in evaluating physicians' performance of fiber-optic bronchoscopy. These are outlined here, along with indications, contraindications, and high-risk situations.
In their move toward greater professionalism and responsibility, respiratory therapists are considering such issues as licensure, education standards, specialization, and prescribing drugs. In this article, views of both respiratory therapists and physicians on these issues are examined.
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