By Angie Marcos
Johns Hopkins’ respiratory care department differs from many across the nation for a myriad of reasons. The one that stands out above all others, however, is the state of specialization and segmentation within the department—but this isn’t a bad thing. On the contrary, it’s one of the most effective strategies at the hospital and one that has both staff and patients pleased with the department’s expertise and glowing reputation.
Anthony L. Bilenki, MA, RRT, is the director of the respiratory care department and ECMO services at Johns Hopkins, overseeing the department’s three divisions—neonatal, pediatric, and adult. Bilenki initially entered the hospital as a clinician in the pediatric ICU, where he worked for 6 years. He then served as supervisor of the pediatric division for 5 years before becoming involved in education and performance improvement for another 5 years. He has been the department director for the past 17 years.
But Bilenki can’t run the department alone. Stacey Mann, BS, RRT, and Matthew Trojanowski, BA, RRT, have come to play crucial roles in the upkeep and management of the respiratory care department as a whole. Mann has served as the manager of the neonatal and pediatric divisions, as well as manager of ECMO services, for 9 years. Trojanowski is new as manager of the adult division. He previously worked as transition coordinator for 1 year, training and educating staff, and has worked as a clinician in the NICU for the past 4 years. This division of labor reflects the department’s vision of separate entities coming together to form one unified respiratory care department.
With the department divided into three units—neonatal, pediatric, and adult—the respiratory care staff has to specialize, becoming experts in treating their patients, whether infants or adults. Generally, the department’s more than 150 RTs do not cross over into other divisions. Instead, the 25 neonatal practitioners, 42 pediatric practitioners, 75 adult practitioners, and 12 managerial and support staff members become experts in their field.
“Many other institutions have staff that rotate across all populations, or at least two of the three populations. One of the major differences is that ours is separated into three divisions,” says Mann. “At a smaller community hospital, the therapists do all of the therapies on all of the patients. In the adult division at our hospital, for example, RTs work primarily in the ICUs. They perform more involved complex therapies on inpatient units, such as monitoring and caring for patients with tracheostomies, CPAP, BiPAP, and other complex modalities.”
Neonatal RTs at Johns Hopkins primarily attend high-risk deliveries in the delivery room, as well as provide full respiratory care support in the NICU, where nitric oxide and surfactant administration services are provided. Neonatal RTs also administer high-frequency oscillation, high-frequency jet ventilation, airway pressure release ventilation (APRV), and intubations. Neonatal RT practitioners are also members of a neonatal rapid response team at the hospital.
The Johns Hopkins Children’s Center is the official pediatric trauma referral center for the state of Maryland. The pediatric RTs respond to all airway-related emergencies, traumas, and respiratory-related internal and external transports, and administer nitric oxide. Extracorporeal membrane oxygenation (ECMO), typically used for longer-term support ranging from 3 to 10 days, is also an important aspect of the pediatric division, with the hospital’s four-bed, recently designated ECMO Center of Excellence. Pediatric RTs additionally serve as members of the hospital’s pediatric rapid response team. In the future, they also will find themselves working with the hospital’s pediatric difficult airway response team.
Meanwhile, the adult division of the Johns Hopkins respiratory care department staffs seven ICUs: cardiothoracic, coronary care, medical, neuroscience, oncology, and two surgical units. Respiratory therapists administer nitric oxide and noninvasive ventilation, and manage and follow lung transplant patients. The division’s RTs also aid in early mobility, such as ambulation of ventilator-dependent patients out of their beds. Adult division practitioners support the emergency department by responding to traumas and codes, aiding with internal transports, and responding to difficult airway and rapid response calls at Johns Hopkins.
The respiratory care department works collaboratively with the hospital’s numerous other departments. Its staff members are part of the multidisciplinary teams in all of the units and are involved in all team meetings as well as daily physician rounds. These activities are part of daily operations for all the RTs in the department.
One main area of focus is to maintain staff competency and keep everyone up to date, as well as foster teamwork among the respiratory therapists, nurses, advanced practitioners, and physicians.
Knowledgeable Staff Is Key
Ensuring that the department’s staff is up to par and happy is vital. As Mann says, “The staff is what keeps the respiratory care department at Johns Hopkins functioning optimally. It’s important to maintain adequate staffing levels and staff satisfaction.”
A major focus is the department’s staff development program. This program allows entry-level practitioners to advance fairly quickly in their divisions, usually within 2 or 3 years. The program is designed to develop staff members professionally in an area that interests them. If, for example, an RT is interested in research, the development program will make an effort to introduce that RT to an ongoing research program in one of the various ICUs or the ECMO program. The staff development program is updated as necessary to keep it current with the goal of providing staff with advancement opportunities that allow them to constantly grow within their divisions.
The department prides itself on being housed in a teaching hospital. For this reason, department management ensures that continued education is easily and readily made available to the RT staff. “We preschedule the staff on one of their days here to participate in maintaining and developing their skills and competency,” says Mann.
A full tuition reimbursement program is now available for employees who wish to pursue a new degree. Several staff members in the respiratory care department have taken advantage of this opportunity and either have completed or are in the process of completing a degree of their choice.
What’s in Store for the Future?
These staff development efforts are all the more important as the department grows. Johns Hopkins recently opened a 1.6 million-square-foot building with many new critical care units and a tower devoted to pediatric care, called The Charlotte R. Bloomberg Children’s Center. The new facility required the department to hire additional RT staff. And with those staff additions, the department’s management is constantly reevaluating the department’s needs to make sure it is not only serving patient needs, but the needs of its RTs.
“We’ve grown to a level where we are looking at the structure of the department. We are asking questions such as ‘Is our current structure meeting the needs of the additional staff we’ve brought on? What, if anything, do we need to add to augment our department and to help support the staff?’ We’re in a state of transition as a department,” said Mann.
But even in a “state of transition,” the respiratory care department at Johns Hopkins hospital is thriving, and looking to the future.
Angie Marcos is associate editor for RT. For further information, contact [email protected]