The Ongoing Evolution of the Enhanced Respiratory Care Program

Michael Wong, JD and Gene Gantt, RRT, FAARC discuss the past, present, and future of the Enhanced Respiratory Care program in the latest podcast episodes.

• Initial development of the Enhanced Respiratory Care partnership

• The many safety and financial benefits created for all involved parties 

• Future plans to improve the standards further and expand on a global level

The Enhanced Respiratory Care (ERC) program began in 2002 as an outline of best practices for optimally weaning patients in Tennessee off long-term mechanical ventilation. The program has since evolved into a national standard of care with a multitude of additional benefits through the partnership with Michael Wong, JD, Executive Director of the Physician-Patient Alliance for Health & Safety (PPAHS), a non-profit advocating for patient health and safety priorities. 

During a recent podcast conversation Michael and the developer of the Enhanced Respiratory Care standards, Gene Gantt, RRT, FAARC, sat down to discuss the program in greater depth, recounting how their partnership came about, the unique benefits for various stakeholders through accreditation and certification, along with looking ahead to what the future holds for the program’s growth. 

How the Enhanced Respiratory Care Partnership was Formed 

Michael Wong and Gene Gantt first met in 2015 during the inaugural conference of the Respiratory Compromise Institute, a coalition of leading medical societies in the United States, and the only non-profit of its kind at the time (the Physician-Patient Alliance for Health & Safety). Talks between the two men developed over their mutual concern regarding the absence of a national standard for respiratory care. 

Michael and Gene were interested in bringing together experts in the field to collectively brainstorm what the national standard for respiratory care should ideally be and see how far that differed from its current state. Early talks were put on hold though, as both Gene and Michael were tied up with other projects.

That all changed during the COVID pandemic when Michael had an idea of how Eventa could fit with his non-profit organization, the Physician-Patient Alliance for Health and Safety (PPAHS). Michael has done a lot of work in the areas of opioids and postoperative monitoring, but the partnership with Gene marked the first initiative for the PPAHS to improve respiratory care. The partnership led to the creation of two distinct pathways for improved respiratory care, individual certification for clinicians, and accreditation for the overarching facilities, with each component of the Enhanced Respiratory Program offering unique benefits. 

Enhanced Respiratory Care Certification vs. Accreditation 

Certification from the Enhanced Respiratory Care program offers clinicians, such as respiratory therapists, nurses, physicians, and even patients, the opportunity to receive education on long-term respiratory care through a number of courses. This marks a rare learning opportunity for long-term care. During the podcast, Gene echoes this sentiment, stating, “One of the issues we ran into as a profession in respiratory care is that not a lot of educational programs exist around the long-term care segment…when you get to long-term care, it just drops off the chart.” 

The program offers seven courses: 

• Culture of a Weaning Program

• Resident Selection

• Quality of Life

• Weaning Approaches

• Ventilator Unit Technology/Equipment

• Process Improvement & Discharge Processes

• Humidified High Flow Therapy or High Velocity Nasal Insufflation

Accreditation is the second component of the program. Accreditation serves as a stamp of approval, signaling that a facility meets or exceeds the national standard of care. All healthcare facilities that care for patients with mechanical ventilation are eligible to apply, and the process involves applying, annual submissions of data, and in-person assessments by PPAHS representatives.  

Prospective applicants need not fear the assessment process though, as the PPAHS isn’t looking to fail anyone but wants to see facilities succeed with these standards of care. “There are no surprise visits,” reassures Gene. “They’ll know when we’re coming and the goal is not to go there and fail them, but to coach them and work with them so they are able to meet those standards.” 

The Benefits of the Enhanced Respiratory Care Program

The Enhanced Respiratory Care program offers a number of benefits for the various parties involved, including patients, families, clinicians, and managed care payers. Patients arguably benefit the most from the standards of care due to the bolstered safety afforded to them.

One such significant component of the standard can be seen through the requirement for licensed respiratory therapists to be on-site at long-term ventilator facilities twenty-four hours per day, seven days a week. This is a significant shift that has the patient’s best interest at heart now. Before the ERC program, Gene recalls that “In many states, there are absolutely no requirements for a respiratory therapist to be in the facility while you’re performing ventilator care.” 

Gene goes on to describe that, while some facilities may require that a respiratory therapist be on call, there could be as many as 50 patients on ventilators in that facility, with “more of a licensed practical nurse with no official training in the field” responsible for their care. The Enhanced Respiratory Care program addresses this danger, ensuring that patients are well-monitored at all times.

Patients receiving optimal care also correlates with their families benefiting as well. The expert recognition offered by the PPAHS program signals to families that their loved ones are in the most capable hands, which equates to emotional reassurance. Michael recounts his experience with this sentiment, stating that, “Families I’ve spoken with know that they can send their loved ones to a place where they have the utmost confidence that they are in capable hands, thanks to the assurance that the facility meets the standard of care.” 

While patient safety is the most prioritized benefit, clinicians and the facilities they are a part of also stand to gain numerous advantages from the ERC program. Certification from the ERC program offers clinicians a rare education opportunity, as long-term care is a burgeoning opportunity in the market. “The market is crowded in terms of pre-hospital and hospital learning opportunities, but long-term care is a nascent field of study, despite how crucial it is to patient well-being,” Gene maintains. 

The modalities that clinicians can access online via the program also provide them with a competitive advantage in the healthcare market. Better-equipped clinicians mean more confidence from families, which results in an enhanced reputation for the facility. Additional financial benefits, such as reimbursement recognition and insurance coverage benefits, also can be achieved through participation in the program.

Emotionally satisfied families also mean fewer lawsuits. Michael can attest from his background as an attorney that, “If you’re having better patient outcomes, clinicians are less likely to get hit with a malpractice suit as a result.” With the Enhanced Respiratory Care program, what benefits one party will benefit all parties on a communal level. 

What’s Next for the Enhanced Respiratory Care Program?  

Despite all the progress the program has already achieved, there is always room to do better, and the plans and initiatives on the horizon are poised to do exactly that. One avenue towards improvement is through continuing work with the ERC Standard Committee Group.  

The group, composed of long-term care experts including nurses, administrators, and pulmonologists, was responsible for the creation of the foundational standards of care that comprise the program as we know it today. In the coming year, Gene plans to work with the committee to review and determine ways to further optimize the standards. 

Michael and Gene also have their eyes set on further global expansion in the coming year. The program has grown substantially in the U.S. from its roots in Tennessee, but what is less known is that there is already a significant presence overseas. Of the current PPAHS members, 15 to 20% are located outside of the U.S. 

The international members are mostly in countries where English is the primary language, such as the U.K. and Australia, but Michael affirms that any country can be involved with the program so long as the physicians can speak English. Even though the models of care are not identical in other countries compared with the U.S., Gene maintains that, “The basic principles will be the same, as all patients at the core are the same. We all have lungs, we all breathe oxygen.” 

By the end of the year, there will be a significant number of facilities accredited, with the intention to expand the continuing education even more internationally with Germany and Europe. Gene and Michael believe, “this is a historic moment in healthcare” and both of the founders couldn’t be more excited to make a mark on the industry while also doing what is in the patient’s and everyone’s best interest as it relates to long-term care.  

Get Involved Today for a Safer Tomorrow 

Get Certified

To take the courses for certification, please visit https://ppahs.org/continuing-medical-education-cme-courses/ 

Get Accredited

To start the accreditation process or ask the PPAHS team any questions about the process, please go to: https://ppahs.org/apply-for-accreditation/.

Watch the Enhanced Respiratory Care Podcasts

To watch the podcasts between Michael Wong, JD and Gene Gantt, RRT, FAARC, please visit: 

• Episode 1 – https://youtu.be/iQfz7S8Bmng

• Episode 2 – https://youtu.be/6BXUh6SDL7Q

 Get Involved

The PPAHS is always looking for volunteers for a wide assortment of tasks. Please visit the “get involved tab” to join the team: https://ppahs.org/get-involved/.

Physician-Patient Alliance for Health & Safety would like to thank their sponsors Breas Medical, Fisher & Paykel Healthcare, and Vapotherm for their unrestricted educational support for the Enhanced Respiratory Care Program. 

Originally published at Physician-Patient Alliance for Health & Safety