Delivering Evidence-Based Respiratory Care (2023)

Respiratory care is a critical component of healthcare, particularly for patients who suffer from chronic or acute respiratory conditions.

Evidence-based practice (EBP) has gained significant attention in recent years as a method to improve patient outcomes by integrating the best available research evidence with clinical expertise and patient values.

Implementing evidence-based in respiratory care not only enhances the quality of care but also streamlines clinical decision-making.

However, there remains a gap between the publication of research findings and their practical implementation at the bedside.

This article aims to explore the current landscape of evidence-based respiratory care, focusing on the strategies for implementation, challenges in adopting EBP, and the measurable impact it has on patient outcomes.

What is Evidence-Based Respiratory Care?

Evidence-based respiratory care refers to the application of the best available scientific evidence, combined with clinical expertise and patient values, to make informed decisions about the care of patients with respiratory conditions.

This approach seeks to standardize care by using treatments and interventions that have been proven effective through rigorous scientific research, such as randomized controlled trials, meta-analyses, and systematic reviews.

Components of Evidence-Based Respiratory Care

The primary components of evidence-based respiratory care include:

• Critical Appraisal of Research: Healthcare professionals involved in respiratory care are expected to critically evaluate the latest scientific evidence. They sift through the research literature to identify the most valid, relevant, and applicable studies to guide their clinical practice.
• Clinical Expertise: While research evidence is crucial, it is also essential to consider the experience and expertise of the healthcare providers delivering respiratory care. Skilled clinicians use their judgment to apply the research findings appropriately in different clinical contexts.
• Patient Values and Preferences: Incorporating the needs, values, and preferences of the patient is another cornerstone of evidence-based practice. Healthcare decisions should be made in a collaborative manner, ensuring that the treatment aligns with the patient’s unique circumstances and wishes.
• Clinical Guidelines: Many medical organizations release guidelines that summarize the best available evidence for treating various conditions. These guidelines serve as a roadmap for healthcare providers, though they should not replace individual clinical judgment.
• Outcomes Assessment: Ongoing evaluation is necessary to ensure that the evidence-based approach is effective in real-world settings. Key performance indicators and patient outcomes should be continually monitored to validate the efficacy of treatments and interventions.

Summary: Evidence-based respiratory care aims to improve the quality of patient care and outcomes by employing a systematic approach to clinical decision-making that is grounded in current scientific evidence, expert judgment, and patient values.

Examples of Evidence-Based Practice

Examples of evidence-based practice (EBP) in respiratory care cover a range of interventions and techniques, often developed through rigorous scientific research and then applied in the clinical setting

Here are some specific examples:

Asthma Management

• Use of Inhaled Corticosteroids: Evidence suggests that long-term use of inhaled corticosteroids is effective in controlling chronic asthma symptoms.
• Peak Flow Monitoring: Regular monitoring of peak expiratory flow rates can help in the early detection of asthma exacerbations.

Chronic Obstructive Pulmonary Disease (COPD)

• Pulmonary Rehabilitation: Clinical guidelines recommend pulmonary rehabilitation as a multi-disciplinary approach to improve physical function and overall well-being in COPD patients.
• Long-Acting Bronchodilators: Use of long-acting inhaled bronchodilators is recommended for managing chronic symptoms in COPD.

Mechanical Ventilation

• Low Tidal Volume Ventilation: For patients with acute respiratory distress syndrome (ARDS), using low tidal volumes (4-8 mL/kg of predicted body weight) is recommended based on strong evidence for improving survival rates.
• Prone Positioning: For severe ARDS, prone positioning is used to improve oxygenation based on evidence that it may lower mortality.

Sleep Apnea

• Continuous Positive Airway Pressure (CPAP): For obstructive sleep apnea, CPAP is the gold standard treatment recommended by multiple guidelines.
• Weight Loss: For overweight individuals with obstructive sleep apnea, weight loss is often recommended alongside other treatments.

Bronchiectasis

• Airway Clearance Techniques: Techniques like postural drainage and percussion are recommended for clearing secretions from the lungs.
• Long-Term Antibiotics: In some cases, long-term antibiotic therapy is advised to prevent frequent exacerbations.

Pneumonia

• Timely Antibiotic Administration: For community-acquired pneumonia, timely administration of the appropriate antibiotics is crucial for better patient outcomes.
• Vaccination: Vaccines against Streptococcus pneumoniae and seasonal influenza are recommended for at-risk populations based on evidence that they can reduce the incidence of pneumonia.

Smoking Cessation

• Nicotine Replacement Therapy (NRT): Evidence supports the use of NRT products like patches, gums, and inhalers for smoking cessation.
• Counseling: Behavioral therapies are supported by evidence as effective strategies for individuals who are trying to quit smoking.

Note: These are just a few examples, but they highlight the variety and depth of evidence-based practices in respiratory care. Each of these practices is supported by a body of scientific evidence that has been appraised and approved by healthcare professionals, ensuring that the highest quality of care is provided to patients with respiratory conditions.

How Does Evidence-Based Practice Improve Patient Care?

Evidence-based practice (EBP) significantly enhances patient care through several key avenues:

• Improved Outcomes: EBP promotes the use of treatments and interventions that have been scientifically proven to be effective. This leads to better patient outcomes, including quicker recovery times, fewer complications, and decreased mortality rates.
• Standardization of Care: EBP helps to standardize methods and treatments across healthcare settings, reducing variations in care and ensuring that all patients receive the same high standard of treatment for their conditions.
• Resource Optimization: By identifying the most effective treatments, EBP helps healthcare systems allocate their resources more efficiently, avoiding the costs and complications associated with less effective treatments.
• Risk Mitigation: EBP guides clinicians in choosing interventions that have been shown to be safe, thereby reducing medical errors and adverse effects, which are detrimental to patient care.
• Patient Engagement: EBP encourages the inclusion of patient preferences and values in treatment decisions. This collaborative approach increases patient satisfaction and compliance with treatment plans.
• Clinical Confidence: Practitioners who follow evidence-based guidelines are better equipped to justify their treatment choices, both to their patients and within the broader medical community.
• Continual Learning: The EBP approach necessitates ongoing review of new research findings, thereby promoting a culture of continuous learning among healthcare providers.
• Transparency and Accountability: When care is based on evidence, it becomes easier to measure performance and hold healthcare providers accountable for the care they provide.

Note: By integrating these elements, evidence-based practice creates a healthcare environment that is more effective, equitable, and focused on delivering the highest quality of care to patients.

Why is Evidence-Based Practice Important?

Evidence-based practice (EBP) is crucial for optimizing patient care and outcomes in a healthcare setting. It serves as a systematic approach to clinical decision-making that integrates the best available scientific evidence, clinical expertise, and patient values.

By doing so, EBP reduces variability in treatment, mitigates the use of ineffective or harmful practices, and fosters a culture of continual learning and improvement among healthcare professionals.

It provides a framework for practitioners to critically appraise and implement current research findings, thereby bridging the gap between scientific inquiry and real-world application.

This not only enhances the quality and effectiveness of care but also contributes to more efficient use of resources.

Moreover, involving patients in the decision-making process respects their autonomy and ensures that their specific needs and preferences are met.

Overall, evidence-based practice is instrumental in elevating the standard of care, improving patient satisfaction, and, ultimately, saving lives.

Evidence-Based Respiratory Care Practice Questions

1. What are respiratory care protocols?
They are guidelines for delivering appropriate respiratory care treatments and services.

2. What are the skills needed to implement protocols?
(1) Assess patients for indications of therapy and the most appropriate method, (2) Be cognizant of age-related issues and how they affect the patient, (3) Adapt hospital policies and procedures to other care sites, (4) Conduct and participate in research activities, and (5) Communicate effectively with all members of the healthcare team and contribute to the body of literature concerning the field of respiratory care

3. What are the nine steps of a quality assurance plan?
(1) Identify the problem, (2) Determine the cause of the problem, (3) Rank the problem, (4) Develop a strategy for solving the problem, (5) Develop appropriate measurement techniques, (6) Implement strategies, (7) Analyze and compile results, (8) Report to appropriate personnel, and (9) Evaluate the outcome

4. What are the professional characteristics of a respiratory therapist?
They must complete an accredited respiratory therapy program. They must obtain professional credentials. They must participate in continuing education activities. They must adhere to the code of ethics put forth by the state or institution. They must join professional organizations.

5. What does CQI stand for?
Continuous Quality Improvement

6. What is evidence-based medicine?
It is an approach that relies on the following practices: A rigorous and systematic review of evidence, critical analysis of available evidence, and a disciplined approach to incorporating the literature with personal experience and practice.

7. What is quality?
In healthcare, quality reflects a high degree of excellence, fineness, or grade.

8. Who is usually professionally responsible for the clinical function of the respiratory department?
A medical director is typically responsible for the respiratory department. They are often either a pulmonologist or anesthesiologist.

9. What are the three elements of quality care?
Personnel, equipment, and the method/manner in which care is provided

10. What are the four essential components of disease management?
(1) An integrated healthcare system that can provide coordinated care across the full range of patient’s needs, (2) A comprehensive knowledge base regarding the prevention, diagnosis, and treatment of disease that guides the plan of care, (3) Sophisticated clinical and administrative information systems that can help assess patterns of clinical practice; and (4) A commitment to continuous quality improvement

11. What is the CoARC responsible for?
It is responsible for the quality of schools’ programs.

12. What are cohort studies?
They compare the clinical outcomes in two compared groups. They generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: (1) Observational cohort studies and (2) Randomized controlled trials.

13. What are competencies?
Having a suitable or sufficient skill, knowledge, and experience for the purposes of a specific task

14. The crucial elements for quality respiratory care include what?
(1) Energetic and competent medical direction, (2) Methods for providing indicated and appropriate respiratory care, (3) Educated, competent respiratory care personnel, (4) Adequate, well-maintained equipment, and (5) Intelligent system for monitoring performance improvement

15. What is disease management?
An organized strategy of delivering care to a large group of individuals with chronic disease to improve outcomes and reduce cost

16. What are protocols?
Guidelines for delivering appropriate respiratory care services that can improve the allocation of respiratory care services

17. What does evidence-based medicine use to find the best care?
It uses meta-analyses to find the best care.

18. What is the “licensing” process for respiratory therapists?
After completion of an approved respiratory care educational program, a graduate may become credentialed by taking the TMC examination and passing with the high-cut score to obtain the CRT credential. A CRT may be eligible to sit for the CSE examination to become a credentialed RRT.

19. What is an important part of evidence-based respiratory care?
Communication

20. What is the Joint Commission (TJC)?
A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

21. What are the primary credentials for respiratory therapists?
RRT (Registered Respiratory Therapist, which is the highest credential); and CRT (Certified Respiratory Therapist)

22. What are the four organizations that sponsor the Committee on Accreditation for Respiratory Care (CoARC)?
(1) AARC, (2) American College of Chest Physicians (ACCP), (3) American Society of Anesthesiologists (ASA), and (4) American Thoracic Society (ATS)

23. What is the medical director?
They are professionally responsible for the clinical function of the respiratory care department, and they provide oversight of the clinical care that is delivered. They are typically a pulmonary/critical care physician or an anesthesiologist.

24. What is misallocation?
Misallocation refers to ordering therapy that is not indicated, ordering therapy to be delivered by an inappropriate method, or failing to provide therapy that is indicated.

25. What is the NBRC responsible for?
They are responsible for the quality of credentialing exams.

26. What is the most rigorous type of study to prove the efficacy of treatment?
Randomized controlled clinical trial

27. What are the tactics for implementing Respiratory Care Protocols?
Select a planning team with a diverse membership, conduct an audit to assess the occurrence of misallocation of therapy to justify departure from usual care, identify sources of resistance (e.g., physicians, nurses, administrators, RTs), design a protocol program that fits the individual hospital, develop a training program for RTs, and develop an evaluation and quality monitoring system.

28. What are the two levels of general practice credentialing in respiratory care?
(1) Certified Respiratory Therapists (CRTs) and (2) Registered Respiratory Therapists (RRTs)

29. What are two ways to monitor quality care?
(1) Institutional and (2) Governmental

30. What is the mission of the CoARC?
To promote quality respiratory therapy education through accreditation services

31. What is the responsibility of CoARC?
To ensure that respiratory therapy educational programs follow accrediting standards or essentials as endorsed by the American Medical Association (AMA)

32. Who sponsors the NBRC?
The AARC, ACCP, ASA, ATS, and the National Society for Pulmonary Technology

34. What three things does quality respiratory care depend on?
Experience, education, and professionalism

35. What three things encompass respiratory care?
The people who administer care, the equipment used, and the manner in which care is provided.

36. What two things determine the quality of services provided by respiratory therapists?
Intelligent efforts to establish guidelines and a method for monitoring the care

37. What is the responsibility of the medical director?
They are responsible for the clinical functions of the program and provide oversight of the clinical care provided.

38. What is the most essential aspect of providing high-quality respiratory care?
To ensure the care being delivered is appropriate and delivered competently

39. What are the four elements one should have for delivering high-quality respiratory care?
Training, education, experience, and professionalism

40. Who is responsible for preparing the budget for the respiratory department?
The medical director

41. Who is responsible for ensuring that respiratory therapy educational programs follow accrediting standards?
CoARC

42. What does CoARC promote?
They promote high-quality respiratory therapy education through accreditation services

43. What is the process in which a government agency gives an individual permission to practice an occupation?
The licensure process

44. What is a term that refers to recognizing individuals in a particular profession or occupation?
Credentialing

45. What is the primary method for ensuring quality in respiratory care?
Voluntary certification or registration

46. Who conducts voluntary credentialing or registration?
The NBRC

47. Who continually monitors the quality inside hospitals and has the ability to shut them down at the same time if standards are not met?
The Joint Commission

48. How do respiratory therapists demonstrate their professionalism?
By maintaining high practice standards, engaging in ongoing learning, conducting research to advance the quality of respiratory care, and participating in organized activities or events

49. What does the P in HIPAA stand for?
Portability

50. Who ensures that the equipment and the associated protocols and procedures have sufficient quality in the department?
The technical director

51. What are the guidelines for delivering appropriate respiratory care treatments and services?
Respiratory care protocols

52. What do protocols reduce?
They reduce the over-ordering of respiratory services

53. What are the two things that are essential for a comprehensive protocol program?
An assessment tool and care plan

54. How is competency tested?
By the use of simulations

55. What is an approach to determining optimal clinical management based on aspects of care?
Evidence-based medicine

56. What three things make up evidence-based medicine?
(1) Systematic review of available evidence, (2) Critical analysis of available evidence, and (3) A disciplined approach to incorporating literature

57. What compares the clinical outcomes of two groups?
Cohort studies

58. What is the most rigorous type of study designed to prove the efficiency of a treatment?
A randomized control trial

59. What does the quality of a respiratory therapist depend on?
Training, experience, education, and professionalism

60. What are the two levels of general practice in respiratory care?
Certified respiratory therapist and registered respiratory therapist

61. How can people become eligible for credentials?
They must have graduated from a CoARC-approved education program.

62. What are the two forms of credentialing?
State licensure and voluntary certification

63. What does technical direction depend on?
Strong leadership

64. What does the manager of the department usually do?
They oversee policies, procedures, and equipment used to provide safe and efficient patient care

65. Why are respiratory care protocols put in place?
They are put in place to enhance the appropriate allocation of respiratory care services.

66. What are the four types of studies that evidence comes from?
Single case studies, case series, cohort studies, and randomized controlled trials

67. What are single case studies?
The simplest and least rigorous

68. What are case series?
A collection of patients with similar clinical features

69. What are cohort studies?
They work by comparing two groups of people and provide greater scientific rigor.

70. What are randomized controlled trials?
They provide the most rigorous evidence and are the ideal choice of study.

Final Thoughts

Delivering evidence-based respiratory care is an imperative that has far-reaching consequences for patient outcomes, healthcare costs, and clinical practice.

While challenges such as lack of access to updated research, limited training, and systemic barriers exist, they are not insurmountable.

Solutions like ongoing education, interprofessional collaboration, and leveraging technological tools can serve to bridge the gap between research and practice.

Ultimately, the integration of evidence-based practices into respiratory care contributes to a more efficient and effective healthcare system, providing patients with the highest quality of care that is grounded in scientific evidence and tailored to individual needs.