A profile of Cincinnati Children’s Hospital, one of the nation’s top-ranked pediatric respiratory care divisions.
By Mike Fratantoro
Sharing, as they say, is caring. And in the Respiratory Care Division at Cincinnati Children’s Hospital Medical Center, the daily care of more than 400 pediatric patients is the shared responsibility of its team of over 200 on-staff respiratory therapists. Cincinnati Children’s Hospital (CCH) is known as one of the leading pediatric care centers in the nation. In fact, 10 of the hospital’s pediatric specialties were ranked in the top 10 for US News & World Report’s 2012-13 Best Children’s Hospitals, including pulmonology (#2) and neonatology (#1)—two specialties in which the hospital’s RTs figure prominently.
But what sets CCH apart from other pediatric respiratory care departments, according to its staff, is its governance structure. The division employs a shared governance model, a system that gives equal input for decision-making to each and every RT in the division, from bedside therapists to clinical managers. Of course, the CCH Respiratory Care Division has the same priorities as any other respiratory department: patient health and comfort, staff satisfaction, and more. But when you have a decentralized governance model that distributes responsibility among so many people, a successful department needs strong communication and leadership from the top.
That’s where Thomas Cahill, RRT-MPS, FAARC, fits in. Cahill is the interim senior clinical director for the CCH Respiratory Care Division, a role he has served in since July 2012. Prior to taking on the interim director role, Cahill was an RT in the division for 3 years, serving as a clinical manager for the hospital’s transitional care center and home care units, which work with long-term ventilation- and endotracheal-dependent patients. He said the division’s motto is: “We want to change the outcome.”
“On a daily basis, our RTs work hand in hand with our physicians to make sure that a patient is going to get the best care they can, and it’s going to be a collaborative, multidisciplinary way of doing it,” Cahill said, adding that, at the end of their shifts, the division’s RTs know that they have made a difference.
Cincinnati Children’s Hospital’s Respiratory Care Division employs 218 respiratory therapists with a full-time equivalent (FTE) of 148.5. Its RTs staff one of five clinical units in the hospital, including its neonatal intensive care unit (75 beds), pediatric ICU (40), cardiac ICU (18), complex airway unit (11), and transitional care center (18). Its RTs also staff the hospital’s “A” building and emergency department, which Cahill said is the busiest pediatric ED in the country. In addition, the division retains 25 RTs as a respiratory resource unit: a reactive team that supports the clinical units and also the 24/7 care, as needed. “There is a lot of specialization within those units,” Cahill said, noting that there is some overlap, but generally his staff reports to a specific clinical unit consistently. His staff believes the specialization is a strength of the division.
“It’s continuity of care,” said Stacy Stetter, RRT, a resource specialist for the division’s respiratory resource unit, where she has worked for 15 years. “[RTs] see their same patients over and over again so they become experts at that population, and that’s very different from most hospitals.
“We’re working with children, and children are totally different from adults. We’re asking parents to put their confidence in us that we’re going to keep their child safe. They know the therapist by name and they trust you,” Stetter said. “I think the continuity is what sets us apart.”
Cincinnati Children’s Hospital Medical Center is licensed for 485 beds and has an average daily census of about 415 to 420 patients, according to Cahill. The illnesses and disorders its RTs frequently treat include asthma, cystic fibrosis, spinal muscular atrophy (SMA-1), and Duchenne muscular dystrophy in its cardiac ICU. In fact, the hospital recently became the third facility in the world to successfully complete a ventricular assist device (VAD) implant into a Duchenne muscular dystrophy patient, Cahill said.
As CCH is a pediatric hospital, its RTs work almost exclusively with newborns to adolescents, but they sometimes treat older patients. “Through our cardiac unit, we’re doing a lot of work with ventricular assist devices, so we’re getting patients who are in their 20s and 30s, and we have a female patient who’s almost 40 years old,” said Cahill, who predicts the division will do more work with this older patient population in the future. “These patients have a need. They have had some type of childhood disease or repair that’s a specialty of a pediatric facility, so we’re seeing more and more of those patients either staying or coming in to our facility for follow-up,” he said.
Although CCH has no delivery wards, the Respiratory Care Division works with the fetal care center on-site during special case deliveries, which can occur during procedures like surgery for congenital diaphragmatic hernia, a fetal condition that can result in respiratory failure due to pulmonary hypertension and pulmonary hypoplasia. “We have RTs in that area where the surgeries are being done and we’re on stand-by in case the mothers do deliver,” said Cahill. “These are only for the specialty cases when we understand that there’s a problem with that parent or with that child.”
A Place for Learning
In addition to its daily responsibilities for patient care, the CCH Respiratory Care Division performs research and also teaches the next generation of RTs. “This is a teaching hospital. We have residents and fellows who are working with us side-by-side on a daily basis. We also affiliate with our local and regional schools of respiratory care and bring in their students,” Cahill said, noting that the division normally has two to five students working with it each day. “Within this region, it’s difficult to get that pediatric experience, so this is a good way for students to see, number one, if they enjoy working with children, and number two, if they do like working with children, it gives us a opportunity to see how well they work and builds us that backlog of people we can look at for positions as they open up within the division.”
Two years ago, the division created a position for a respiratory care research specialist, which has greatly increased its amount of research. “We’ve seen an increase in the bedside clinical research that we are producing. Last year, 15 abstracts were submitted and accepted for presentation by the AARC,” Cahill said. “Through research, we get to mold the future of what new treatments are coming out and how effective they are going to be for our patients.”
The CCH Respiratory Care Division places a high priority on staff development, with the hope that investments in staff will increase job satisfaction and create more staff expertise and better results for patients. The division employs a clinical ladder system that develops staff from RT-1 to RT-2 and RT-3 and gives them opportunities for professional development based on their interests, such as education, research, special projects, or leadership. “It gives [RTs] professional development and job satisfaction; it also improves the care that we’re providing to our patients on a daily basis,” Cahill said. “We want to make sure that our staff are satisfied with the job they are doing, that we have the right person with the right education and they have the right tools at the right time to take care of the patient.”
Staff development plays a role in the division’s shared governance model, which “gets the bedside therapists to be involved in the decision-making—not simply taking orders—but actually being involved in the decisions on the care that the patients are getting on a daily basis,” Cahill said. RTs sit on a number of hospital councils and participate in department policy research that can have hospital-wide impacts. “It makes RTs more vested,” added Stetter. “Being able to make those decisions, you really are making differences in those children’s lives.”
Cincinnati Children’s Hospital is growing, and the Respiratory Care Division is growing with it. The hospital is adding beds in its neonatal ICU, cardiac ICU, and transitional care center, which means hiring additional RT staff. The division is also restructuring, based on results of a consultant review, to add some 24/7 supervision and more layering to help bedside RTs with the day-to-day operations. Research will play an equally important role in the division’s future, as it looks to get more manuscripts published so that it is “setting the bar for pediatrics,” Cahill said.
Just who will lead these changes has yet to be determined. The division is currently searching for a permanent senior clinical director, a position that demands a well-qualified candidate, according to Cahill, its interim director. “They need to be in touch with the bedside therapists. They need to be innovative. They need to be passionate about what they are doing and about working at this hospital and promoting this hospital and this division,” he said. Cahill plans to apply once he completes his master’s degree in July. His time in the position has taught him it is a role that must always be looking ahead.
“When you’re working with children, you feel like there’s a lot more at stake because you’re dealing with a future,” Cahill said. “With adults, it’s more based on a past: ‘What’s gotten them to this point and how can we get them through this acute phase?’ But with pediatrics you’re looking at ‘What future does this child have and how can I make sure that they get to that future?'”
If Cincinnati Children’s Hospital’s track record is any indication, its patients are not only looking at a bright future, but with the help of the hospital’s highly qualified and highly motivated RTs, these children will surely get there.
Mike Fratantoro is chief editor of RT. For further information, contact editor@RTmagazine.com.