The Rapid Implementation of Ad Hoc Tele-Critical Care Respiratory Therapy (eRT) Service in the Wake of the COVID-19 Surge

Margarete Pierce; Steven W Gudowski; Karsten J Roberts; Anthony Jackominic; Karen K Zumstein; Amanda Shuttleworth; Joshua Ho; Phillip Susser; Alomi Parikh; John M Chandler; Ann Marie Huffenberger; Michael J Scott; C William Hanson 3rd; Krzysztof Laudanski

doi:10.3390/jcm11030718

The Rapid Implementation of Ad Hoc Tele-Critical Care Respiratory Therapy (eRT) Service in the Wake of the COVID-19 Surge

J Clin Med. 2022 Jan 29;11(3):718. doi: 10.3390/jcm11030718.

Authors

Margarete Pierce¹, Steven W Gudowski¹, Karsten J Roberts¹, Anthony Jackominic¹, Karen K Zumstein¹, Amanda Shuttleworth¹, Joshua Ho², Phillip Susser², Alomi Parikh², John M Chandler³, Ann Marie Huffenberger⁴, Michael J Scott^{4

5}, C William Hanson 3rd^{4

5}, Krzysztof Laudanski^{4

5

6}

Affiliations

¹ Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
² Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁴ Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁵ Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁶ Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk #210, Philadelphia, PA 19104, USA.

Abstract

A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT^®) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio-visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as "routine" based on established workflows, 4.71% as "urgent", 0.26% "emergent", and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient-ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.

Keywords: ARDS; COVID-19; PENN E-LERT®; compliance; critical care; intensive care; pandemic; respiratory therapist; teleICU; telemedicine; virtual medicine.