1. Improving Physician Therapist Collaboration Paul L. Goldiner M.D.,D.D.S Medical Director, Respiratory Therapy BMCC Emeritus Professor, Anesthesiology Mt. Sinai School of Medicine

2. Qualities M.D.’s Value in a Respiratory Therapist Compassion Communication Critical Thinking Detail Orientation

3. Attributes Communication Participation Professionalism

4. Communication Speak the M.D.’s Language

5. Steps to achieve this begins in school.

6. Participation Clinical Economic Research

7. Economic Engagement Service -hospital committees, etc. Employee engagement -outcome evaluation -risk management -productivity evaluation

8. Research Participation Respiratory Care: 2004, June; 42 (6) 600-5 Results of a Physician and Respiratory Therapist Collaborative Effort to Improve Long Term Metered-Dose Inhaler Technique in a Pediatric Asthma Clinique.

9. Professionalism Therapist driven protocols are the gold standard in M.D.-Therapist collaboration.

10. How They Would Work Therapy adjusted more frequently to changes in patient’s status. M.D.’s contacted for major changes, not minor adjustments. -eliminates nuisance calls Consistency of therapy is maintained. -non-pulmonary M.D.’s assure proper care by requesting protocol therapy.

11. Protocols RCP’s actively involved in achieving good outcomes. -rather than performing rote tasks Raises the level of the profession.

12. Advantage of Protocols Avoids misallocation of respiratory care Improves the quality of care Cuts costs

13. Without Protocols, multiple studies have identified the problem which includes: -poorly ordered oxygen therapy, incentive- spirometry, bronchodilator therapy, ABG’s, etc.

14. Today Inappropriate care is unacceptable in the current health care environment When the protocols are used = improved care

15. Protocol Based Respiratory Care Reduced Inappropriate Care By: 61% bronchial hygiene (Shapiro et al.) 59% aerosol medications (Zibrak et al.) 92% IPPB (Zibrak et al.) 55% Incentive Spirometry (Zibrak et al.) 72% ABG’s in ICU (Browning et al.) 48% basic care (Hart et al.)

16. Study Published in Chest by the ACCP Evaluation of the effectiveness of respiratory therapy driven protocols -694 consecutive patients -safe -greater agreement with institutional treatment plans than with MD directed care -overall rate of discordant respiratory care orders were significantly less than MD directed care

17. Respiratory Therapy Driven Protocols Enhance Professionalism.

18. Characteristics of Successful Respiratory Therapists -from Advance, September 2012 By Jimmy Thacker

19. Be a Competitor Be Smart Be a Turtle Have Ideas Use Your Instincts Be a Leader Be Special Be Confident Have a Head for Business Schmooze on a PRN Basis