Not only does Rainbow Babies and Children’s Hospital, Cleveland, have a long history of serving children in Cleveland and greater Ohio—more than 120 years to be exact—the respiratory therapists working in the pediatric respiratory care department do as well.
Thirty-four years ago, Marsha Rogers came to Rainbow as secretary of the respiratory care department right out of high school. Stepping through the department’s doors put her on a path to a 30-plus year career as a respiratory therapist at Rainbow and made her a part of a family of RTs working to help the children they treat go home to their own families.
“I’ve never left here,” said Rogers, CPT, NPS, staff respiratory therapist. “I think it’s a great respiratory family, and I think every therapist brings a different dimension to the family.”
A Range of Care
Pediatrics is a bit of a misnomer when describing the patients seen by RTs in the pediatric respiratory care department at the 244-bed pediatric specialty hospital, which is a part of the University Hospitals Case Medical Center. While the bulk of Rainbow’s patients range in age from premature infant to 18, the hospital, and the pediatric respiratory care department specifically, treat a number of patients into early adulthood for chronic conditions, as well as older adult patients who receive care at the hospital’s Cystic Fibrosis Care Center where the same doctors treat both children and adult CF patients.
Since the pediatric respiratory care department at Rainbow was founded in 1964, the department has grown to serve a range of patients suffering from a range of conditions. In addition to the CF Care Center, the department’s RTs staff the asthma care unit, the 23-bed pediatric intensive care unit (PICU)—which includes the hospital’s cardiac surgery patients—a 38-bed neonatal intensive care unit (NICU), and a 44-bed step-down for the NICU. RTs at Rainbow can also be found in the pediatric pulmonary function testing laboratory, as well as the hospital’s level I trauma center and emergency department. In addition, department RTs are present at the high-risk deliveries at MacDonald Women’s Hospital, which is also part of the University Hospitals system.
Approximately 10,000 newborns, infants, children, and adolescents are admitted annually to Rainbow, which has been ranked one of America’s best children’s hospitals by U.S. News & World Report, including earning a 10th place ranking in the respiratory disorders category in 2010. In addition, the hospital’s ambulatory clinic and children’s emergency center serve more than 100,000 children each year. Kathleen Deakins, MSHA, RRT, NPS, FAARC, clinical manager of the women’s and children’s respiratory care and respiratory diagnostic services at Rainbow, estimates that about 70% of the patients admitted to the hospital or seen in the emergency department have respiratory-related types of disease.
The presence of the pediatric respiratory care department’s RTs in almost every corner of the hospital means they are often there to see a patient’s care all the way through.
“As we staff the high-risk delivery room [at MacDonald Women’s Hospital], we’re right there at delivery. And if a baby requires intubation at that time, we have therapists who are intubating and transporting the baby back over to Rainbow’s NICU and then onto the vent. So it’s beginning to end,” says Rogers.
Truth to the Cliché
While it may be a cliché, the key to ensuring that patients treated by the department’s 32 full-time RTs get the best care is teamwork. And it’s the prevailing descriptor for the relationship between RTs and the rest of the hospital staff.
“We have a really close relationship with nursing. They very much depend on our RTs,” says Deakins, who has been at Rainbow since 1982. “They consult us for a lot of things, and they know we’re their backup on a lot of things.”
That good rapport and sense of teamwork also holds true for the RTs’ relationship with the hospital’s doctors. Given Rainbow’s affiliation with Case Western Reserve University as a teaching hospital, the department’s RTs find themselves working with interns, residents, fellows, and attendings.
“We are very involved in teaching residents and helping them learn respiratory protocols and some of the reasons we do things. They depend on us as well,” says Deakins.
Adds Susan Palmer, RRT, a staff respiratory therapist who has been at Rainbow for 22 years, “We’re an integral part of all the kids’ care—along with nursing, the physicians, and physical therapy. It’s definitely a team approach where everyone needs to do what they need to do for each individual child.”
Leading the Way
One role the pediatric respiratory care department often finds itself filling is that of innovator—a role that demands a lot of energy, but which Deakins says is well worth it.
The department was responsible for introducing Intrapulmonary Percussive Ventilation for airway clearance in the pediatric population; and is now looking at introducing Metaneb, another method of airway clearance. The department also introduced t-piece resuscitation in the hospital, which is now standard practice in their delivery rooms and NICU. The RT staff was also instrumental in starting the division-based asthma care path, which, over the years, has made its way into both the NICU and emergency department.
The department also takes research seriously, and, according to Rogers, management is receptive to research initiatives proposed by department RTs. Every year, the department makes a presentation at the American Association for Respiratory Care annual meeting, whether it be an equipment-based project or an evaluation of a protocol. This year, the department will present its findings from a survey of students from six clinical affiliates on their awareness of the National Patient Safety Goals that pertain to RTs in the hospital. This focus on research projects—like a recent effort to look at different methods for securing ET tubes in the NICU—is part of a department-wide initiative to continually contribute and move the field forward.
On this front, the department also hosts the annual Rainbow Respiratory Conference—the next one will be held in August. In its 13th year, the all-day conference draws over 150 RTs and other health care professionals dealing with pediatric respiratory issues from all over Ohio, and as far as Pennsylvania. Lectures are aimed at not only pediatric RTs but RTs working in units where a pediatric respiratory patient might be seen—such as an emergency department where a pediatric patient might come for stabilization before being transferred to a pediatric specialty hospital like Rainbow. The aim of the conference is to educate and to use the resources at Rainbow’s disposal to do so. As Deakins describes it, it’s an opportunity for the department to provide a service to “the respiratory community.”
What Does It Take?
To say that one must like kids to work in the pediatric respiratory department at Rainbow would be simplistic. Flexibility and good communication skills are also important, according to Deakins.
“You have to be able to take into account that you have a patient and a family to interact with, not just a patient. You have to be sensitive to things that are going on around you,” says Deakins. “In addition, there is a lot of technology and a lot more switching and changing [between modalities] than there is in adult care. So, basically, you have to have a creative spirit.”
The majority of the department’s RTs are ICU trained, says Deakins. And while the staff primarily rotates within the ICUs or among the other divisions, they are not exclusive and staff are able to cross over. Typically, a minimum of two RTs staff each ICU, and most days there is an RT who floats between the areas. In addition, two to three RTs staff each division, depending on the shift.
Staying Up to Speed
To keep the department’s RTs up to speed on new technologies, therapies, and protocols, the department’s management relies on continuing education and in-service training, including scenario-based competency training, as well as interactive, online education tools. According to Deakins, the department has been doing more simulation-based testing with a SIMBaby and mechanical ventilation so that RTs get more hands-on training.
“It makes it more real than when you were just watching a PowerPoint and writing things down,” says Deakins. “The interactive thing really seems to drive the points home more so than other methods do.”
Educational and information resources like these, combined with the fact that over 90% of the department’s full-time RTs have advanced credentials specific to neonatal/pediatric respiratory care, serve to create a highly skilled RT staff.
“We spend a lot of time getting people competent,” says Deakins. “We have an innovative and proactive department.”
As Rogers puts it, the department “offers every single person a chance to excel at what they’re good at.” And each person, she adds, “brings a different dimension” to the department. “Some are excellent technology wise; others have years of experience. I think the combination of the two provides the ultimate care for our patients.”
A Place to Belong
At the end of the day, the goal of the RTs in the pediatric respiratory care department at Rainbow is to provide the best care to the children they treat—through both the good times and the bad.
“You see these kids when they’re not doing so good. Seeing someone so young having to endure some of the things they do before they get better is difficult,” says Palmer. “But at the same time, it makes you just feel good that you can be there for them too.”
And it’s those good moments that make it worthwhile.
“I just see a lot of resilience in these kids—even the sickest of the sickest kids. They always have a smile. They can bounce back. They are full of life. They make you happy,” says Palmer.
It’s that ability to find the good times amid the hard times that has led people like Deakins, Palmer, and Rogers to commit their professional careers to treating the pediatric respiratory patients at Rainbow.
“I think it takes a special person to [work in pediatrics] because it is heartbreaking at times—it’s extremely heartbreaking at times,” says Rogers. “But for the people who work here, maybe it’s the pull of a child’s smile that you’ve done something for, or a child’s touch that tells you, ‘Wow, I need to do this. This is where I belong.'”
Alison Werner is associate editor for RT. For further information, contact [email protected]