RT education and COVID-19 pneumonia discharge quality

Background There is a lack of data assessing the influence of respiratory therapist (RT) education on clinical outcomes. The primary objective of this study was to evaluate the impact of RTs holding advanced degrees or completing adult critical care competencies on discharge outcomes of patients with COVID-19 pneumonia. Study Design and Methods This retrospective, cross-sectional study included adults with confirmed COVID-19 admitted to the hospital for at least three days between March-May 2020. The academic degree held by each RT was considered advanced (baccalaureate or higher) or associate degree. Discharge outcomes were considered good, compromised, or poor when subjects' hospital discharge was directly to home, long-term care facility/rehabilitation center, or hospice/died, respectively. A time-to-event multi-state regression model was used to determine the impact of RT academic degree and adult critical care competencies on discharge outcomes using alpha=0.05. Results A total of 260 subjects (median age 59 y; 166 males) received clinical care from 132 RTs. RT median professional experience was six y (IQR 3-11), 70.8% had an advanced degree, and 70.8% completed adult critical care competencies. The time-to-event multi-state regression model showed that patients with >85% exposure to RTs with advanced degrees transitioned 3.72 times more frequently to good outcomes than RTs without advanced degrees (p=.001). Similarly, patients with >85% exposure to RTs with adult critical care competencies transitioned 5.10 times more frequently to good outcomes than RTs without adult critical care competencies (p<.001). Conclusion Patients with COVID-19 pneumonia who received greater than 85% of their care by RTs who earned advanced degrees or completed adult critical care competencies had improved discharge outcomes. This preliminary work suggests that advancing education for the respiratory therapist workforce may improve the discharge quality of patients with acute respiratory failure and should be further explored.