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RESPIRATORY CARE SERVICES

BWH -Medical Director: Elliot Israel, M.D.

Respiratory Therapy covers 24 hours/day, with reduced coverage on weekends/holidays. Initiation of respiratory therapy services requires a written order, recorded in the Doctors' orders. Once an order is written, the nursing staff or secretary contacts RT staff. Renew orders (except ventilators) at 72 hours. To contact the respiratory therapists:

Respiratory Therapy Supervisors: beeper 11194

Home Care Referrals: Monday - Friday, 7 am - 3 pm, beeper 13678; off shift and weekends, page beeper 13175.

Floors Beeper (7 am - 7 pm) Beeper (7 pm - 7 am)
ED, PACU,
3, 4, 5, 6 12616 11886
7 11886 11886
8 11874 11874
9 11873 11873
10, 11, 12 13175 13175
14, 15, 16 12616 13175

Respiratory Therapy offers the following services:

• initiation and maintenance of mechanical ventilators


• oxygen therapy


• aerosol therapy


• airway care


• attendance at Codes Blue and Green


• bedside pulmonary function testing when PFT lab is closed after 5 pm weekdays and or weekends and holidays


• tests and procedures for evaluation of patients on mechanical ventilators:
  respiratory mechanism (maximum inspiratory pressure, tidal volume, vital capacity); VD/VT, VC02, calorimetry


• provision of referrals for home respiratory care services.

Chest Physical Therapy
Chest Physical Therapy coverage is available 7 am - 5 pm weekdays with limited coverage weekends and holidays. Pulmonary consult patients requiring chest PT after 5 pm are given special priority. Therapists covering weekends and holidays provide treatment to patients who need it most.
Initiation of Chest PT services requires a written order. Once an order is written, the nursing staff or secretary contacts the CPT staff or department. CPT offers the following services:

* breathing exercises
* mobilization techniques (percussion, vibration/shaking, postural drainage when appropriate)
* patient education for those with chronic respiratory diseases, instruction of patients and family members in at-home CPT procedures

Chest physical therapists act as a consult service and, under the supervision of the Medical Director, amend or discontinue CPT services as patient's condition indicates. When CPT services are discontinued, nursing participation in delivery of these services is discontinued as well.

Outpatient Pulmonary Rehabilitation

Medical Director: John J. Reilly, Jr., M.D.
617-732-4757; fax 617-732-7421; Tower 4A; Hours: Monday - Friday, 7 am - 4:30 pm
Clinical Coordinator: Simons, BS, RN, R.R.T.
Exercise Physiologist: Karyn Birkenmaier, MS

The Pulmonary Rehabilitation Program is a multi-disciplinary, comprehensive full service program designed to improve the functional status of patients with breathing problems. Patients with diagnosis of emphysema, chronic bronchitis, asthma and cystic fibrosis may benefit from this individualized program. Pulmonary rehabilitation services provided include evaluation, personalized exercise plan and group exercise classes, patient education seminars and breathing retraining. Exercise tolerance testing is performed for pulmonary rehabilitation candidates. Chest physical therapy is available on an out-patient basis.

Initiating a Referral
Physician referral on a staff consult form, via e-mail to a staff member or by physician narrative letter is required for all services.

Criteria
* dyspnea at rest or with exertion
* reduced exercise tolerance and/or reduction in the ability to perform ADLs
* an unexpected deterioration that includes worsening symptoms
* patient is pre-operative and rehabilitation will maximize medical status
* patient’s oxygen saturation results will require the initiation of supplemental oxygen or change in oxygen prescription.

MGH RESPIRATORY CARE SERVICES

Director: Robert Kacmarek, Ph.D., R.R.T.
Ellison 401724-4480; fax 617-724-4495
Medical Director: C. Alvin Head M.D.
Charge Therapist beeper 24225

The Department of Respiratory Care Services provides inpatient services 24 hours/day, 7 days/week. The department is staffed with registered respiratory therapists who are assigned to cover all adult, pediatric and neonatal patient care areas, including the Emergency Department. There is a respiratory therapist assigned to each inpatient area at all times who is easily accessible through the hospital paging system. The staff on each floor has the appropriate page number for the respiratory therapist assigned to that area.

The department is responsible for the setup, adjustment and monitoring of all mechanically ventilated patients throughout the institution. Mechanical ventilation during hyperbaric oxygen therapy is managed by a respiratory therapist. Respiratory therapists administer medicated aerosol therapy, perform pulmonary mechanics and metabolic studies and supervise the weaning of ventilated patients. Respiratory therapists actively participate in educational programs for asthma and COPD patients.

Respiratory therapists also manually ventilate and assist with the transport of patients to and from diagnostic areas within the hospital. Special arrangements for out-of-hospital transport of mechanically ventilated patients should be made in advance by paging the charge therapist (beeper 24225).

Respiratory therapists are members of the code call team and respond to STAT cardiac and airway management emergencies. They are certified ACLS and Neonatal Resuscitation providers. They provide artificial airway assistance and consultations, noninvasive ventilation and high flow oxygen therapy. Extracorporeal membrane oxygenation is provided by a group of specially trained respiratory therapists who are on call 24 hours/day.

Respiratory therapists also assist with high-risk deliveries. Respiratory therapists are available to assist physicians with all bronchoscopies performed outside the operating room by paging beeper 28331.

Patients who are admitted to the hospital with their own personal home respiratory care device or ventilator should be referred to the charge therapist (beeper 24225). These devices must be evaluated for electrical safety. Biomedical Engineering calls are triaged by a respiratory therapist after 4 pm Monday through Friday and on weekends and holidays. All biomedical engineering calls should be directed to 617-724-1333.