Teresa Volsko - Academia.edu (original) (raw)
Papers by Teresa Volsko
Respiratory Care, Feb 1, 2003
Respiratory Care, Mar 1, 2008
Thesis (M.H.H.S.)--Youngstown State University, 2004. Includes bibliographical references (leaves... more Thesis (M.H.H.S.)--Youngstown State University, 2004. Includes bibliographical references (leaves 38-41).
Respiratory care
Changes in health care delivery, reimbursement schemes, and organizational structure require heal... more Changes in health care delivery, reimbursement schemes, and organizational structure require health care organizations to manage the cost of providing care while maintaining high levels of clinical and patient satisfaction outcomes. As an integral part of the health care system, respiratory care departments must contribute to organizational goals that assist with the achievement and maintenance of financial viability. In order to compete on the basis of cost and quality, it is essential to collect and process accurate, timely, and complete clinical quality outcomes and financial information. Integrated computerized systems for order entry, clinical documentation, revenue-capture, and decision support specific to the needs of respiratory care departments are commercially available. These systems are designed to automate clinical documentation, work load assessment, quality monitoring initiatives, billing, and result reporting, and they have demonstrated favorable results. 1 Although the value of a respiratory care management information system is difficult to dispute, the cost is often prohibitive. 2 Consequently, many respiratory care departments lack such resources and must rely on clinicians to collect and analyze the data through cumbersome, nonautomated processes. Complex and time-consuming methods often negatively impact the population a respiratory care department serves, through the consumption of valuable time that could be better spent delivering bedside care.
BACKGROUND: The purpose of this study was to explore the prevalence, setting, sources, and types ... more BACKGROUND: The purpose of this study was to explore the prevalence, setting, sources, and types of disruptive behavior respiratory therapists experience. Three hypotheses were tested: (1) respiratory therapists experience disruptive behavior in the workplace; (2) verbal disruptive behavior is the most common form reported by respiratory therapists, (3) the incidence of disruptive behavior is higher among bedside caregivers than managers or educators. The greatest source of disruptive behavior is described. METHODS: A 23-question survey gleaned data to evaluate disruptive behavior respiratory therapists may witness or experience at their place of employment. This research was approved by the institutional review board and informed consent was obtained prior to participation. The survey was distributed electronically to respiratory therapists who were members of the American Association for Respiratory Care’s adult acute care, management and education specialty sections. RESULTS: A t...
Respiratory care
A substantial amount of consumer health-related information is available on the Internet. Studies... more A substantial amount of consumer health-related information is available on the Internet. Studies suggest that consumer comprehension may be compromised if content exceeds a 7th-grade reading level, which is the average American reading level identified by the United States Department of Health and Human Services (USDHHS). To determine the readability of Internet-based consumer health information offered by organizations that represent the top 5 medical-related causes of death in America. We hypothesized that the average readability (reading grade level) of Internet-based consumer health information on heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes would exceed the USDHHS recommended reading level. From the Web sites of the American Heart Association, American Cancer Society, American Lung Association, American Diabetes Association, and American Stroke Association we randomly gathered 100 consumer-health-information articles. We assessed each arti...
Respiratory care, 2004
Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they ... more Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they have in business and education environments. This report explores the health care application of PDAs, compares available PDA devices and software, and discusses PDA use for tracking patients, documenting clinical procedures, medical education, research, and accessing medical reference material. This report aims to increase awareness among health care providers about the potential roles of PDAs and to encourage further evaluation of PDAs in respiratory care.
Respiratory Care, 2013
Disease processes can impair ciliary function, alter secretion production and mucus rheology, and... more Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma. Although challenges to performing clinical studies evaluating the effectiveness of airway clearance therapeutic modalities exist, resources are available in the literature. In addition to device evaluations and original clinical research, the expert opinion, systematic reviews, and evidence-based practice guidelines can be found. These tools can be used to develop protocols and pathways to guide our practice. Monitoring and reporting patient, process, and financial outcomes are essential steps germane to the implementation of evidence-based care.
Respiratory Care, 2009
The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded t... more The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded throughout the years. As key members of the multidisciplinary team, respiratory therapists actively participate in the medical management of patients with cystic fibrosis along the continuum of care, from acute in-patient stays to the out-patient clinic and/or home setting. Through their involvement in diagnostic testing, administering therapy, or direct bedside care, patient and caregiver education, and disease management, respiratory therapists strive to preserve lung function, maintain overall health, and improve the patient's quality of life.
Respiratory Care, Dec 1, 2006
OBJECTIVE: The purpose of this study was to determine the effect of protocol-directed recommendat... more OBJECTIVE: The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities. METHODS: We studied patients who required oxygen therapy in 17 Ohio-based skilled nursing facilities. Respiratory therapists assessed the need for oxygen therapy. Recommendations for oxygen use and orders were made in accordance with an algorithm-based protocol and guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1 through March 31, 2005. RESULTS: Of 346 eligible patients, 261 had complete data and comprised the study sample. The mean ؎ SD age was 83 ؎ 11.8 years, and 79% were male. Payer mix included Medicaid (46%), Medicare Part A (36%), private pay (11%), and hospice (7%). Orders for oxygen therapy were incomplete or missing in 18% of the population. A total of 1,175 billed days were saved, which corresponded to a cost savings of $6,768. CONCLUSIONS: Successful implementation of an oxygen protocol can improve compliance with accreditation agency requirements by reducing the number of missing and/or incomplete orders for oxygen therapy. Financial and patient outcomes can also be enhanced by discontinuing unnecessary oxygen use and initiating oxygen therapy when clinically needed.
Critical care medicine, 2015
Respiratory care, 2006
The purpose of this study was to determine the effect of protocol-directed recommendations for ox... more The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities. We studied patients who required oxygen therapy in 17 Ohio-based skilled nursing facilities. Respiratory therapists assessed the need for oxygen therapy. Recommendations for oxygen use and orders were made in accordance with an algorithm-based protocol and guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1 through March 31, 2005. Of 346 eligible patients, 261 had complete data and comprised the study sample. The mean +/- SD age was 83 +/- 11.8 years, and 79% were male. Payer mix included Medicaid (46%), Medicare Part A (36%), private pay (11%), and hospice (7%). Orders for oxygen therapy we...
Respiratory Care Clinics of North America, 2001
The successful management of pediatric thoracic injuries includes immediate and careful evaluatio... more The successful management of pediatric thoracic injuries includes immediate and careful evaluation of the injury type and severity. Early treatment can be conservative in nature or require surgical management. Prompt intervention can reduce morbidity and mortality rates, associated complications, and ensure optimal outcomes.
Respiratory Care, Feb 1, 2003
BACKGROUND: Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates se... more BACKGROUND: Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > 15 L/min and one for < 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. METHODS: We measured oscillatory amplitude, PEP, and frequency. Values for frequency, peak, trough, and mean pressure were recorded automatically every 3 seconds at flows of 5, 10, 15, 20, 25, and 30 L/min. The pressure waveform for 1 second was also graphically displayed and recorded. The devices were adjusted to give low, medium, and high mean expiratory pressure (Flutter angle at 0, 20, and 40°; Acapella by dial setting). Data were analyzed by 2-way repeated measures analysis of variance, and differences were considered significant when p was < 0.05. RESULTS: There were statistically significant differences between the devices for mean pressure, pressure amplitude, and frequency, for all experimental conditions. However, the differences were relatively small and may not be clinically important. Both devices produced similar pressure waveforms at the medium flows. At 5 L/min the Acapella produced a more stable waveform, with a lower frequency, higher amplitude, and a slightly wider range of PEP than the Flutter. CONCLUSIONS: Acapella and Flutter have similar performance characteristics. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.
Respiratory Care, 2008
suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cl... more suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cleveland Clinic an expected hospital expansion of 350 beds by 2008 has increased the need for RT staff. This report describes a strategy by which we developed a plan, in concert with local RT colleges, to recruit RTs. METHODS: Local RT managers were surveyed regarding demand for RTs. We developed a recruitment plan, based on discussions with RT program directors. RE-SULTS: The survey data and models estimated an annual mean of 33.4 new positions in northeast Ohio. Despite the fact that approximately 84 people graduated from northeast Ohio RT programs yearly in 2004 to 2007, the growth in demand for RTs exceeded the estimated supply. The main factor that caused RT schools to limit the supply of RTs was the paucity of clinical sites. Our analysis shows the schools could achieve a 40% increase in student output, and that if the Cleveland Clinic could essentially double its graduate hires, all RT staff needs in our hospital would be met by 2010. CONCLUSIONS: To assure a needed supply of RTs, this work shows the value of modeling supply and demand scenarios, coupled with surveying local RT leaders and fostering dialog between local RT leaders in hospitals and colleges. The product of this activity was a strategy for achieving recruitment goals while assuring that other regional demands for RTs are also met. We recommend this approach to colleagues facing similar challenges.
Respiratory Care, Feb 1, 2003
Respiratory Care, Mar 1, 2008
Thesis (M.H.H.S.)--Youngstown State University, 2004. Includes bibliographical references (leaves... more Thesis (M.H.H.S.)--Youngstown State University, 2004. Includes bibliographical references (leaves 38-41).
Respiratory care
Changes in health care delivery, reimbursement schemes, and organizational structure require heal... more Changes in health care delivery, reimbursement schemes, and organizational structure require health care organizations to manage the cost of providing care while maintaining high levels of clinical and patient satisfaction outcomes. As an integral part of the health care system, respiratory care departments must contribute to organizational goals that assist with the achievement and maintenance of financial viability. In order to compete on the basis of cost and quality, it is essential to collect and process accurate, timely, and complete clinical quality outcomes and financial information. Integrated computerized systems for order entry, clinical documentation, revenue-capture, and decision support specific to the needs of respiratory care departments are commercially available. These systems are designed to automate clinical documentation, work load assessment, quality monitoring initiatives, billing, and result reporting, and they have demonstrated favorable results. 1 Although the value of a respiratory care management information system is difficult to dispute, the cost is often prohibitive. 2 Consequently, many respiratory care departments lack such resources and must rely on clinicians to collect and analyze the data through cumbersome, nonautomated processes. Complex and time-consuming methods often negatively impact the population a respiratory care department serves, through the consumption of valuable time that could be better spent delivering bedside care.
BACKGROUND: The purpose of this study was to explore the prevalence, setting, sources, and types ... more BACKGROUND: The purpose of this study was to explore the prevalence, setting, sources, and types of disruptive behavior respiratory therapists experience. Three hypotheses were tested: (1) respiratory therapists experience disruptive behavior in the workplace; (2) verbal disruptive behavior is the most common form reported by respiratory therapists, (3) the incidence of disruptive behavior is higher among bedside caregivers than managers or educators. The greatest source of disruptive behavior is described. METHODS: A 23-question survey gleaned data to evaluate disruptive behavior respiratory therapists may witness or experience at their place of employment. This research was approved by the institutional review board and informed consent was obtained prior to participation. The survey was distributed electronically to respiratory therapists who were members of the American Association for Respiratory Care’s adult acute care, management and education specialty sections. RESULTS: A t...
Respiratory care
A substantial amount of consumer health-related information is available on the Internet. Studies... more A substantial amount of consumer health-related information is available on the Internet. Studies suggest that consumer comprehension may be compromised if content exceeds a 7th-grade reading level, which is the average American reading level identified by the United States Department of Health and Human Services (USDHHS). To determine the readability of Internet-based consumer health information offered by organizations that represent the top 5 medical-related causes of death in America. We hypothesized that the average readability (reading grade level) of Internet-based consumer health information on heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes would exceed the USDHHS recommended reading level. From the Web sites of the American Heart Association, American Cancer Society, American Lung Association, American Diabetes Association, and American Stroke Association we randomly gathered 100 consumer-health-information articles. We assessed each arti...
Respiratory care, 2004
Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they ... more Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they have in business and education environments. This report explores the health care application of PDAs, compares available PDA devices and software, and discusses PDA use for tracking patients, documenting clinical procedures, medical education, research, and accessing medical reference material. This report aims to increase awareness among health care providers about the potential roles of PDAs and to encourage further evaluation of PDAs in respiratory care.
Respiratory Care, 2013
Disease processes can impair ciliary function, alter secretion production and mucus rheology, and... more Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma. Although challenges to performing clinical studies evaluating the effectiveness of airway clearance therapeutic modalities exist, resources are available in the literature. In addition to device evaluations and original clinical research, the expert opinion, systematic reviews, and evidence-based practice guidelines can be found. These tools can be used to develop protocols and pathways to guide our practice. Monitoring and reporting patient, process, and financial outcomes are essential steps germane to the implementation of evidence-based care.
Respiratory Care, 2009
The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded t... more The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded throughout the years. As key members of the multidisciplinary team, respiratory therapists actively participate in the medical management of patients with cystic fibrosis along the continuum of care, from acute in-patient stays to the out-patient clinic and/or home setting. Through their involvement in diagnostic testing, administering therapy, or direct bedside care, patient and caregiver education, and disease management, respiratory therapists strive to preserve lung function, maintain overall health, and improve the patient's quality of life.
Respiratory Care, Dec 1, 2006
OBJECTIVE: The purpose of this study was to determine the effect of protocol-directed recommendat... more OBJECTIVE: The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities. METHODS: We studied patients who required oxygen therapy in 17 Ohio-based skilled nursing facilities. Respiratory therapists assessed the need for oxygen therapy. Recommendations for oxygen use and orders were made in accordance with an algorithm-based protocol and guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1 through March 31, 2005. RESULTS: Of 346 eligible patients, 261 had complete data and comprised the study sample. The mean ؎ SD age was 83 ؎ 11.8 years, and 79% were male. Payer mix included Medicaid (46%), Medicare Part A (36%), private pay (11%), and hospice (7%). Orders for oxygen therapy were incomplete or missing in 18% of the population. A total of 1,175 billed days were saved, which corresponded to a cost savings of $6,768. CONCLUSIONS: Successful implementation of an oxygen protocol can improve compliance with accreditation agency requirements by reducing the number of missing and/or incomplete orders for oxygen therapy. Financial and patient outcomes can also be enhanced by discontinuing unnecessary oxygen use and initiating oxygen therapy when clinically needed.
Critical care medicine, 2015
Respiratory care, 2006
The purpose of this study was to determine the effect of protocol-directed recommendations for ox... more The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities. We studied patients who required oxygen therapy in 17 Ohio-based skilled nursing facilities. Respiratory therapists assessed the need for oxygen therapy. Recommendations for oxygen use and orders were made in accordance with an algorithm-based protocol and guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1 through March 31, 2005. Of 346 eligible patients, 261 had complete data and comprised the study sample. The mean +/- SD age was 83 +/- 11.8 years, and 79% were male. Payer mix included Medicaid (46%), Medicare Part A (36%), private pay (11%), and hospice (7%). Orders for oxygen therapy we...
Respiratory Care Clinics of North America, 2001
The successful management of pediatric thoracic injuries includes immediate and careful evaluatio... more The successful management of pediatric thoracic injuries includes immediate and careful evaluation of the injury type and severity. Early treatment can be conservative in nature or require surgical management. Prompt intervention can reduce morbidity and mortality rates, associated complications, and ensure optimal outcomes.
Respiratory Care, Feb 1, 2003
BACKGROUND: Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates se... more BACKGROUND: Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > 15 L/min and one for < 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. METHODS: We measured oscillatory amplitude, PEP, and frequency. Values for frequency, peak, trough, and mean pressure were recorded automatically every 3 seconds at flows of 5, 10, 15, 20, 25, and 30 L/min. The pressure waveform for 1 second was also graphically displayed and recorded. The devices were adjusted to give low, medium, and high mean expiratory pressure (Flutter angle at 0, 20, and 40°; Acapella by dial setting). Data were analyzed by 2-way repeated measures analysis of variance, and differences were considered significant when p was < 0.05. RESULTS: There were statistically significant differences between the devices for mean pressure, pressure amplitude, and frequency, for all experimental conditions. However, the differences were relatively small and may not be clinically important. Both devices produced similar pressure waveforms at the medium flows. At 5 L/min the Acapella produced a more stable waveform, with a lower frequency, higher amplitude, and a slightly wider range of PEP than the Flutter. CONCLUSIONS: Acapella and Flutter have similar performance characteristics. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.
Respiratory Care, 2008
suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cl... more suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cleveland Clinic an expected hospital expansion of 350 beds by 2008 has increased the need for RT staff. This report describes a strategy by which we developed a plan, in concert with local RT colleges, to recruit RTs. METHODS: Local RT managers were surveyed regarding demand for RTs. We developed a recruitment plan, based on discussions with RT program directors. RE-SULTS: The survey data and models estimated an annual mean of 33.4 new positions in northeast Ohio. Despite the fact that approximately 84 people graduated from northeast Ohio RT programs yearly in 2004 to 2007, the growth in demand for RTs exceeded the estimated supply. The main factor that caused RT schools to limit the supply of RTs was the paucity of clinical sites. Our analysis shows the schools could achieve a 40% increase in student output, and that if the Cleveland Clinic could essentially double its graduate hires, all RT staff needs in our hospital would be met by 2010. CONCLUSIONS: To assure a needed supply of RTs, this work shows the value of modeling supply and demand scenarios, coupled with surveying local RT leaders and fostering dialog between local RT leaders in hospitals and colleges. The product of this activity was a strategy for achieving recruitment goals while assuring that other regional demands for RTs are also met. We recommend this approach to colleagues facing similar challenges.