As respiratory care evolves, the AARC plays an important role in preparing RTs for the future.
The first recorded mention of respiratory care occurred in 410 BC, when the father of medicine, Hippocrates, advocated the use of “air treatments.” The profession has obviously come a long way since then, and the American Association for Respiratory Care (AARC) is proud to have played an instrumental part in that evolution.
In the Beginning
Looking back to the 1940s when Edwin R. Levine, MD, first began training his medical assistants to perform respiratory therapy, you will find the formation of the earliest predecessor of the AARC, the Inhalation Therapy Association (ITA). Among that group’s goals were to promote higher standards in methods and the professional advancement of association members and to advance the knowledge of the profession.
Although the semantics have changed somewhat over the years, those fundamental goals for the association have remained basically the same. It was in that spirit of progression and advancement that the ITA evolved, ultimately becoming the association you know today as the AARC. And although the organization has undergone many name changes since 1947, it has always retained its foundational commitment to advancing the respiratory therapy profession.
Among its early contributions was the formation of the two key agencies that form the basis of the practice of respiratory therapy in the United States: the Board of Schools and the American Registry of Inhalation Therapy. You know the Board of Schools as the Committee on Accreditation for Respiratory Care (CoARC), the accreditation arm of the profession that assures respiratory therapy programs in schools are covering the educational needs of RTs. And the American Registry of Inhalation Therapy is today’s National Board for Respiratory Care (NBRC), the credentialing arm of the profession that tests respiratory therapists to ensure they are learning the basic foundation of knowledge that the marketplace needs respiratory therapists to know.
These two groups promote the highest levels of ethics and professionalism in respiratory therapy. The establishment of these groups was key to the future development of the profession and to how therapists are increasingly being perceived as quality care professionals in the marketplace today.
The Recent Past
Now, let us take a closer look at the AARC’s contributions over the past 10 or 15 years. Although some areas into which the respiratory therapist’s role has expanded are very distinct, the AARC has also facilitated many general advances for therapists across the board.
Perhaps one of the most important projects has been the AARC’s undertaking of providing a scientific basis for respiratory care practice with the promulgation of clinical practice guidelines (CPGs). Practice guidelines are common in many disciplines and are developed for a variety of reasons. The AARC’s CPGs exist for the noblest reasons–to improve the quality of respiratory care administered to patients. The variability in clinical practice from one hospital to another had been well known, and these variations had been coming under increasing scrutiny over the years. The AARC responded to this variability by publishing its first five CPGs in 1991 and has continued to take a leadership role in the development of CPGs to improve the appropriateness of respiratory care practice throughout the country. The association currently has 49 available CPGs. These CPGs, more than any other resource or activity, have solidified a basis for the practice of respiratory therapy.
Another important contribution, which has spurred changes in the educational foundation of our profession, has been two Educational Consensus Conferences sponsored by the AARC in the early 1990s. These conferences identified the skills and knowledge that were integral to the respiratory therapist’s education. The conferences did not just focus on the input of a group of respiratory therapy educators, but rather relied on input from respiratory care employers–respiratory therapist managers and other nonrespiratory administrators and physicians. Since they are the “purchasers” of the respiratory therapist “product” coming out of our nation’s schools, the AARC considered it vital to get their input and perspective on what kind of therapist they needed for the future.
On the basis of these meetings, the AARC and other respiratory care agencies promulgated a position statement that has led to the mandate for a 2-year degree requirement for entry-level therapists by 2002. The AARC adopted the “Respiratory Therapist Education” Position Statement in March 1998. It was the result of many years of studies and other projects like the Educational Consensus Conferences that clearly showed the expanding role of the RT called for a minimum of 2 years of preparation in an accredited respiratory therapy education program. This new requirement will help ensure that well-educated, highly skilled therapists are entering the job market prepared to meet the many challenges and opportunities of a career in respiratory therapy.
Understanding its obligation to provide its members with education that will help prepare them for new opportunities, the association also offers a plethora of education and management aids such as educational satellite conferences and videos, Individual Independent Study Packet (IISP) self-study workbooks, and even online continuing education programs. One particularly successful course has been the AARC’s course on patient assessment. This program helps respiratory therapists and other health care professionals to understand how to provide accurate, overall patient assessment. This material will help the respiratory therapists who are expanding their roles into other health care settings and are providing a broader range of services to patients. This course and many other tools designed by the AARC provide direction for the professional growth of AARC members and therapists across the board. Facilitating individual successes, the association is contributing to the expansion of the profession as a whole, one therapist at a time.
Skills like those taught in the Patient Assessment Course were identified as important assets in an AARC study undertaken with the Lewin Group in 1997 called “Respiratory Care Practitioners in the Evolving Health Care Environment.” This research provided us with keen insight into what the marketplace needed and expected from today’s respiratory therapists and from therapists in the future. The association used information garnered through this study to help determine the focus of our educational curricula and also to help choose which therapist qualities we should promote to RT employers.
Another key to the advancement of respiratory care practice in this country lies in protecting the interests of the profession in Washington, DC, and in gaining support for its growth from influential figures on Capitol Hill. For better or worse, health care professions expand and contract through government regulation. With two full-time lobbyists in Washington, the AARC is working every day to ensure that Congress is aware of the profession’s concerns.
The notable projects described above are landmarks that have contributed to the expanded practice of respiratory therapists. However, the AARC provides other essential information on a continuing basis through the Respiratory Care Journal and other resources as well as through presentations at our Summer Forums and International Respiratory Congresses.
The leadership that the AARC offers to its members and to the profession on an ongoing basis has contributed to the successful evolution of the profession and to expanded areas of practice for therapists.
Specific Areas of Advancement
Aside from the general expansion of the respiratory profession, the AARC has seen the respiratory therapist’s scope of practice broaden profoundly over the past decade or more. In each of the following cases, the AARC has always endeavored to lead the way for respiratory therapy and to help usher RTs into these new venues as well-prepared health care professionals ready to make a difference.
Although some may see the role of reasearcher as a newly emerging one for the respiratory therapist, the AARC has been encouraging RTs to do research for years. In fact, almost 20 years ago the association’s Respiratory Care Journal published the “Clinical Research Guide” (Vol 25, No 1, Pt 2, January 1980). From “Searching the Literature” to “Publishing the Study,” the Journal‘s guide broke down the research process step by step. What is more, the Journal, the only peer-reviewed scientific publication produced expressly for the respiratory care professional, has been publishing respiratory therapists’ research since its inception in 1956.
As you can see, the association has always recognized the importance of respiratory therapists doing clinical research and having that work made available for the benefit of the profession as a whole. A more recent move to encourage research has been the AARC’s establishment of the $1 Million Research Fund. The association set aside this significant amount of money in 1996 to sponsor research that determines relationships between clinical interventions by respiratory therapists and the outcomes of patient care. As more concrete correlations between respiratory therapists and positive patient outcomes are published, the entire profession will reap the benefits.
Skilled Nursing Facilities
AARC saw the potential for respiratory therapists’ success in this care setting back in the early 1990s and developed the Subacute Care Specialty Section to provide therapists working in this area with an outlet for networking and sharing ideas. Since then, the association has continued to foster an atmosphere of growth and expansion for respiratory care practice in the skilled nursing facility (SNF).
One of the ways the AARC has helped develop the practice of respiratory care in the SNF has been to provide tools and educational programs that support respiratory therapists’ comprehension of their role in this environment. Last year, for example, we developed the Uniform Reporting Manual for Subacute Care. This guidebook gives respiratory care managers the information they need to determine productivity, promote standardization of care, and determine personnel needs. And we have also provided educational programs to our members in this area. For example, last year the AARC offered an audio teleconference designed to educate practitioners about the new SNF prospective payment system (PPS). This program gave RTs an understanding of what they had seen as a formidable threat to their careers; we helped them grasp how to make that system work for them rather than against them.
But more important than the administrative tools and educational programming we offer is the work we continue to do on behalf of the profession in Washington, DC. Speaking out on Capitol Hill about the need for quality respiratory care in SNFs was our primary focus in 1998, and we have continued to push for changes in SNF reimbursement regulations and for requiring proof of respiratory therapy competency.
We have commissioned several studies related to this issue; of particular import is the Muse Study, released last fall. It showed clearly that flaws exist in the Health Care Financing Administration (HCFA) methodology used to construct the SNF PPS system. Muse and Associates, a well-known Washington-based consulting firm, used HCFA data compiled from the 1994 and 1996 Standard Analytical Beneficiary Encrypted Public Use Files to show that serious gaps are inherent in the Resource Utilization Group (RUG) III system of reimbursement.
The association also has joined a coalition of other respiratory service providers and a coalition of nontherapy ancillary providers, has hired high-powered Washington consultants to draft our comments to HCFA, has gathered a powerful group of physicians to address this issue on our behalf, has met with influential Senate committees, and has made contact with several consumer groups. The association has taken this issue very seriously and is working every day to secure the RT’s place as a vital contributor to the SNF health care team and to assure the safety of SNF patients.
Patients with chronic pulmonary disease are especially suited to having their ongoing medical needs managed in the home. This is another emerging health care role for respiratory therapists.
The AARC also saw a need for guidance in providing home care services, so we teamed up with the Pennsylvania Society for Respiratory Care to make available the Respiratory Care Home Care Procedure Manual. This resource defines procedures fundamental to home respiratory care practice ranging from routine services like aerosol therapy to specialized care like mechanical ventilation. Another excellent resource for home care professionals has been the AARC Home Care Specialty Section. This unique group offers home care respiratory therapists a way to network with other professionals from across the country who share similar interests and concerns.
Again, the many tools and resources for home care would be worth nothing if the AARC had not relentlessly pushed for the RT’s entry into home care as a cost-effective, life-enhancing health care provider. The respiratory therapist’s role in home care flourished beginning in the early 1980s when a study published in Respiratory Care Journal showed that services delivered to lung patients by RTs translated into fewer readmissions to the hospital and shorter lengths of stay when they were readmitted. Certainly it has also received a boost under managed care, because many managed care companies have seen the economic benefits of using RTs in the home.
Just as with SNF care, the AARC’s focus on expanding the RT’s role into home care has provided therapists with more opportunities and given them confidence that they can succeed and provide a valuable contribution in this area.
Respiratory therapists have been forging their way into the realm of diagnostics in increasing numbers. The AARC saw this new venue opening up for RTs and set out to make them as prepared as possible. First, the association created the Diagnostics Specialty Section and also held in 1988 an in-depth conference on pulmonary function testing during which therapists learned about the evolution of the process and about the equipment options of the day.
The association has also recognized that sleep diagnostics holds opportunities for RTs and addressed that topic at a conference in 1997. Conference faculty reviewed the current state-of-the-art in diagnosis and management of sleep-disordered breathing and highlighted the emerging role of the RT in the care of patients with this condition.
The association also plans to release later this year a new management resource tool, The Uniform Reporting Manual for Diagnostic Services. This guide will help respiratory managers determine productivity, track trends in the utilization of services, and assist in determining personnel requirements.
The concept of disease management (DM) has been gaining in popularity since the early 1990s, and programs run by respiratory therapists have shown themselves to be among the most successful. This stands to reason, as respiratory diseases lend themselves very well to preventive care. Respiratory therapists have been able to step into DM programs and use their knowledge and expertise to make profound contributions.
Recognizing the respiratory therapist’s key part in asthma disease management, the AARC has had for many years a representative in the National Asthma Education and Prevention Program (NAEPP). One particular video resource from the AARC, “Asthma Disease Management: Using the Revised NAEPP Guidelines in Practice,” gives viewers a good look at the NAEPP Guidelines, which are essential to asthma disease management. The AARC also has other resources designed to help hone the skills of RTs interested in disease management. The Asthma Disease State Management video, for example, provides instruction on how to create an effective asthma disease management program addressing diagnosis, pharmacological
therapy, environmental controls, and patient/family education.
The association also offered a 3-day disease management postgraduate course in San Antonio earlier this year, and a second course later this year will focus specifically on asthma disease management.
Related to the concept of disease management is case management, which holds interest for many RTs. However, until the AARC stepped in back in 1994, respiratory therapists were not even eligible to take the credentialing examination to become certified case managers (CCM). The AARC took the necessary action to spur change in the Commission for Case Manager Certification system, which has led to many respiratory therapists earning the CCM credential.
Adult non-ICU Care
Although adult non-ICU care has been a mainstay for respiratory therapist employment, it has nevertheless evolved over the years and RTs have contributed to that growth. In fact, respiratory therapists in the AARC created the Adult Acute Care Specialty Section fostering a network for RTs working in the adult acute care field.
One primary new facet to non-ICU respiratory care involves the increasing use of patient driven protocols (PDPs). More than 5 years ago, an AARC study showed that 60percent of responding institutions had implemented protocols or had immediate plans to do so. Recognizing the significance of this emerging practice, the AARC took the lead in teaching RTs how to write and implement effective protocols through state-of-the-art conferences, written resource guides, and model protocols to follow.
Patients in the ICU require specialized care, and the AARC has gone to great lengths to ensure that RTs have the opportunity to meet those career challenges. The association has a history of consistently encouraging therapists to achieve a higher level of clinical skills in general, and this applies particularly to therapists working in the ICU. Many educational conferences over the years have focused on health care practices used primarily on critically ill patients, encouraging therapists to sharpen their skills for this type of care. For example, conferences have focused on issues like mechanical ventilation, pharmacology, and oxygenation in the critically ill patient. The association has also developed a sample curriculum for a postgraduate course on the placement and management of intravenous lines.
The Respiratory Care Journal and AARC Times are both excellent sources for the newest information for respiratory therapists working in the ICU as well as those who encounter the many other facets of the therapist’s expanding role in health care. Electronic copies of recent back issues of AARC publications and more information about the other services and resources described here are available on the Internet at AARC Online: www.aarc.org, or call (972) 243-2272.
Numerous issues have been presented here about the AARC’s contribution to the expansion of the respiratory therapist’s role in health care; however, the most significant point for you, the respiratory therapist, to remember is this: the AARC consistently does whatever it takes to help RTs stay on the cutting edge of the health care profession. As the health care system has changed over the years, the respiratory therapist’s role has shifted accordingly–and you can be sure that more changes are on the horizon. As that eventuality occurs, remember to look to the AARC for guidance on what those changes are bringing for the respiratory profession.
Kelli Hagen is the communications coordinator for the AARC in Dallas.