health consist of a group of trained professionals, like

health care management

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Maria Gabriela vintimilla Andrade (86)

Case No. 5        

You are a new
administrator at a hospital, well known for pulmonary medicine. The physicians
in the ICU, the ER, and the Department of Pulmonary Medicine have demanded to
meet with you about the shortage of Respiratory Therapists. You stall them for
48 hours so you can gather data. What types of information will you need to
collect to have an intelligent conversation with this powerful group of


Intensive care unit (ICU) is a specialized
section of a hospital that provides intensive care to patients suffering from
life threatening injuries or illnesses. An ICU is equipped with complex and
specialized equipment designed to monitor and assist in physiological
functions; these include monitors to measure heart rate, blood pressure and
respiratory rate, while ventilators help patients to breath. An ICU also
consist of a group of trained professionals, like nurses, clinical nurse
specialist, respiratory therapists, doctors, pharmacists amongst others. The
major five reasons patients are admitted to an ICU are respiratory
insufficiency or failure, postoperative management, ischemic heart disorder,
sepsis, and heart failure. ( Encyclopedia of Surgery, 2015)

A respiratory therapist is a trained
professional specialized in cardiopulmonary diagnosis, treatment and
monitoring. The RT responsibilities include interviewing patients, executing
chest exams, analyzing tissue specimens, analyzing blood oxygen, determining
patient’s breathing capacities and educating patients on the use of ventilators
and life support systems. During emergencies such as a Code Blue the RT plays
an important role in managing and assisting to this type of situations (University of Kansas Medical Center, 2015). In the ICU setting
respiratory therapists have an active role in ventilator management, using both
invasive and non-invasive ventilation techniques.  Furthermore, they insert Radial Arterial Line,
assist with percutaneous tracheostomy and bronchoscopy, they do intubations and
extubations, and other measures required during a respiratory emergency. A RT
not only is required in the adult ICU but also is a very important member of
the Special Care Nursery, they set up oxygen, administer surfactant, and manage
infant ventilators and infant continuous positive airway. Overall, a
respiratory therapist is a very important part of a healthcare system (St. Luke’s Hospital , 2015).

As mentioned above patients in the ICU are
mainly treated for cardiopulmonary diseases and postoperative care. Therefore,
the major causes of death in the ICU include multi-organ failure,
cardiovascular failure, and sepsis. Among the patients with sepsis, half of
them will develop renal failure, about a quarter will develop acute respiratory
failure, and over 80% will have either a myopathy or a polyneuropathy. It is
estimated that the overall mortality rate in the ICU is about 30%. Recent
studies have demonstrated that these rates can drop up to a 6% when the ICU has
an adequate number of qualified staff; in comparison, it has also been proven
that the mortality rates increase when there is lack in number or coalification
of the ICU staff (Society of Critical Care Medicine, 2015).


the current case, as a hospital administrator is my responsibility to know the
hospital budgeting and financing plans. As the physicians have requested the
addition of Respiratory Therapists, is my duty to find all the data possible to
accept or deny such request. In order to make this decision, the data to be
collected needs to show ICU admission rates in the past last year, ICU costs,
Morbidity and Mortality rates, respiratory costs, success rate, employment
costs and revenues generated. Once I have obtained all the data then, I can
make a decision regarding the addition of new staff.

Data and statistics1

ICU costs

In the United States, the number of ICU
beds has increased over the years, it is estimated that over 5 million patients
are admitted to the ICU every year (Society of Critical Care Medicine, 2015). While ICU beds
account for 15% of all inpatients beds, ICU costs account for a third of all
inpatient costs.  These high costs are related
to a higher staffing ratio, higher use of services and resources, and a longer
stay at the ICU. (Dahl, et al., 2012).

ICU admissions

The ICU patients are a heterogeneous
population, of all ages and ethnicity, however, children and adolescent are at
a high range of 18% of all admissions (Society of Critical Care Medicine, 2015). In the adult
population, the major diagnosis at admission are respiratory diseases, diabetes
ketoacidosis, coronary artery bypass, and cerebrovascular accident (Dahl, et al., 2012). Among the neonate
population, the major diagnosis at admission are respiratory problems,
infections, hemolytic jaundice, premature birth, and fluid and electrolyte
misbalance (Society of Critical Care Medicine, 2015).

Morbidity and Mortality rates

Mortality and Morbidity rates are directly
linked to duration of stay, being higher the longer the patient stays. As
mentioned before the mortality rate ranges between 15-30%.

Respiratory costs

Respiratory costs increases with the
length of stay. Therefore, the first day it is estimated to be around 50,000
USD, as the stay lengthens the cost increases, being so that by the 50th
day after admission it can be as high as 300,000 USD (Dahl, et al., 2012).

Employment costs

The ICU is composed by a team of
professionals, the salary for this varies according to the position. The
following is the list of the estimated salary in dollars for a year (Society of
Critical Care Medicine, 2015):

Critical care staff physician:  $261,383

Critical care staff nurse: $74,330

Critical care nurse practitioner: $100,406

Respiratory therapist: $56,1821

Critical care clinical pharmacist:


After carefully analyzing all the data
above mentioned, I can sit with this group of physicians and consider the
possibility of adding new staff. As a hospital administrator my key concern is
to optimize the hospital resources and offer and excellent health service. My
main goal is to reduce costs without affecting patient care. As mentioned
above, the ICU treats life-threatening conditions and the success of this
relies on a carefully chosen group of specialists.

The respiratory therapist is a very important
member of this group. The shortage on respiratory therapist can bring many
disadvantages to the hospital. The first disadvantage will be an increase in
all costs. Firstly, the length of stay will increase, and as seen in the analysis
the longer the patients stay the higher the costs are. Secondly, the mortality
rates increase when the ICU staffing is not adequate, a shortage of RT would
contribute to an increased mortality rate; as a secondary adverse effect of a
higher mortality rate, a family member can suit the hospital for malpractice or
insufficient resources, causing us an unnecessary and preventable cost. Another
disadvantage is that if the hospital success rates decrease due to the shortage
of RT, the patients will no longer want to go to this hospital, they will ask
for transfers, this can severely decrease the revenues generated.

should consider that maybe there are other alternatives to reduce costs instead
of keeping a low staffing. For example, by reducing the length of stay, I’m
directly reducing the costs. Immediate and effective treatment of diseases,
will help reducing the number of days a patient needs to stay hospitalized. Having
a 24 hours intensivist team has shown to optimize care and reduce costs. By
having the adequate staff during an emergency, over $13 million annually can be
reduced. As seen above, the major causes of admission to an ICU are of
respiratory origin. In the current case, this hospital is well known for their
respiratory department, therefore, it makes sense that we should prioritize
respiratory care and optimize it in the best way, even if it implies hiring new
staff. The new addition might be an additional cost, but it can help us reduce
and prevent future costs.


The ICU and the ER are departments that
treat life-threatening conditions, the combination between good equipment and
adequate staff ensure a positive outcome. The RT is a specialist well trained
to respond to emergencies such as Code Blue and to treat cardiopulmonary
conditions. Regarding the case study, the hospital is well known for their
respiratory medicine, which implies, that more patients needing the assistance
of an RT are admitted. In my opinion, is optimal to have more RTs to ensure a
satisfactory patient care.

As the hospital administrator, I need to
consider all variables before making a decision. The data I need to collect has
to prove or deny that is possible to hire more staff. These data includes,
hospital records, admissions to the ICU and ER departments, length of stay
during ICU, ICU admission rates, mortality and morbidity rates, employment
costs and financial budgeting; all the data has to be within the past last
year. Finally, I need to take into consideration that a negative outcome due to
staff shortage, can lead to a hospital suit; a lawsuit costs a lot of money and
is something we should avoid. Once I have collected all the data, I would have
an intelligent conversation with these physicians and we could together come to
an understanding.



Encyclopedia of Surgery. (2015). Intensive Care
Unit. Retrieved from
D., Wojtal, G. G., Breslow, M. J., Holl, R., Huguez, D., Stone, D., &
Korpi, G. (2012, November/December). The High Cost of Low-Acuity. Journal
of Healthcare Management. Retrieved from
of Critical Care Medicine. (2015). Critical Care Statistics. Retrieved
from The intensive care profesionals:
Luke’s Hospital . (2015). Respiratory Therapy. Retrieved from
Pulmonary Services:
of Kansas Medical Center. (2015). What is a Respiratory Therapist?
Retrieved from Respiratory Care Education:





For purposes of this exercise all the data and statistics has been taken from
previous studies made in different hospitals of the USA