Management and processing of respiratory care information in respiratory care departments.

BACKGROUND: Though much research has been done to determine best practice and to examine the role of evidence-based guidelines and respiratory therapist (RT) driven protocols in enhancing patient care and reducing health care costs, very little attention has been paid to how respiratory care information is managed and processed. OBJECTIVE: To examine information systems currently used in respiratory care departments to determine if they are effective and efficient in managing and processing respiratory care information. METHODS: To 50 RTs at 16 respiratory therapy departments in New York, Houston, and Miami, we distributed questionnaires designed to determine the strengths, weaknesses, and usefulness of existing respiratory care information systems. There were 2 types of questionnaire: one for respiratory care managers and another for staff RTs. We used a combination of purposive and snowball sampling techniques to choose RTs to whom to send the survey. RESULTS: The response rate was 52%. Of the 26 respondents, 19 were staff RTs and 7 were managers. In the 16 departments that responded, 3 of the information systems were strictly paper-based, 12 were partially automated (combination of paper records and computer files), and 1 was fully automated. The respondents' opinions about the usefulness of their information systems were: 19% said "very useful," 23% said "useful," 46% said "somewhat useful," and 12% said "not useful." All the respondents said that they rely on colleagues, books, and manuals for decision support, rather than on computerized decision-support systems. CONCLUSIONS: This study suggests that the information systems used by the respondent RTs have marginal utility and have problems with data storage and retrieval, because either the systems do not employ computerized databases or the computerized databases do not have full-scale database management systems. Inadequate data storage and retrieval systems often lead to data redundancy and, ultimately, inaccurate information. Development of data models specific to the respiratory care profession may be necessary to build databases with conceptual schemas that accurately reflect the professional activities of RTs.

Pediatric nerve agent poisoning: medical and operational considerations for emergency medical services in a large American city.

Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions.