Evaluation of a Virtual Respiratory Therapist Model for Augmenting On-Site Respiratory Care by Registered Nurses

Background:Health care facilities that choose not to utilize 24-hour on-site respiratory therapist coverage, such as some freestanding emergency departments, critical access hospitals, and skilled nursing facilities, rely on other licensed health care professionals to assume such clinical responsibilities. The use of a virtual respiratory therapist via a telehealth cart provides another alternative. The current evaluation investigates the accuracy and efficiency of registered nurses (RNs) utilizing a remote virtual respiratory therapist in the absence of an on-site respiratory therapist. Methods:Institutional review board was consulted, and determined that this evaluation was exempt. In a simulated patient room, 20 emergency room RNs were guided by a virtual respiratory therapist via a telehealth cart in the following procedures: 1) initial starting up and entering initial ventilator settings on an acute care ventilator and a transport ventilator, 2) changing ventilator settings, 3) starting up and entering initial BIPAP settings, and 4) changing BIPAP settings. The accuracy was calculated based on the number of tasks completed correctly divided by the total number of tasks assigned in each procedure. Efficiency was measured based on the time taken for completing each procedure. For comparison, the same procedures were performed independently by 10 respiratory care practitioners (RCPs) and were evaluated using the same parameters. Results:As shown in Table 1, RNs utilizing a virtual respiratory therapist took longer to perform all procedures. A two-sided, two-sample t-test with equal variance assumption showed that this difference was statistically significant. The RNs exhibited 100% accuracy, as did the RCPs, in changing ventilator and BIPAP settings and in initial starting up of the transport ventilator. However, the accuracy of initial starting up and entering initial settings on the acute care ventilator (97.8%) and BIPAP (99.0%) were slightly less in the RN group than in the RCP group (100%). Conclusions:Although it was possible for a virtual respiratory therapist to assist RNs in completing tasks remotely via a telehealth cart, facilities interested in pursuing this staffing model will need to consider the extra time needed to perform these tasks and the potential for decreased accuracy in completing tasks as compared to staffing a respiratory therapist on-site at all times. Disclosures: No potential conflict of interest.Average time to complete each procedure (minutes: seconds) Acute care ventilator setupChange acute care ventilator settingsBIPAP setupChange BIPAP settingsTransport ventilator setupChange transport ventilator settingsRN3:300:561:120:220:450:17RCP1:220:220:480:180:320:10RN, registered nurse; RCP, respiratory care practitioner