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Respiratory: Expanding Scope of Practice in Hospitals

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Respiratory: Expanding Scope of Practice in Hospitals
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Respiratory: Expanding Scope of Practice in Hospitals
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RTs are now able to provide an increasing number of services.

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RTs are now able to provide an increasing number of services.

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News By Profession

Respiratory Health

RTs are now able to provide an increasing number of services

By Lindsey Nolen

The role of respiratory therapists (RTs) in the hospital setting is increasingly important, as they provide potentially life-saving care to trauma patients. Also responsible for treating people with healthcare issues affecting the cardiopulmonary system, these professionals are prepared to treat a variety of conditions including asthma, emphysema, pneumonia, cardiovascular disorders and trauma.

"Traditionally, the respiratory therapist role in acute-care hospital settings was providing medication, oxygen therapy, and ventilator support," explained Khaja Khan, RCP, president of Aerovu Technologies Inc. in San Rafael, Calif. "That has changed in recent years, as they now also provide services to patients in need of sleep medicine utilizing CPAP and BiPAP machines, which are non-invasive devices that are critical in their care."

Respiratory: Expanding Scope of Practice in Hospitals

Line of Work

Working with patients of all ages, from premature infants with underdeveloped lungs to senior citizens with advanced chronic obstructive pulmonary disease (COPD), respiratory therapists may be found in acute-care hospital settings. These environments include the emergency room, intensive care unit, newborn or pediatric intensive care unit, or pulmonary diagnostics laboratory, according to Respiratory Therapist License, a site detailing the specific licensing requirements enforced by each state's board of respiratory care.

Always practicing under medical direction, RTs additionally focus their efforts on the development and implementation of treatment plans and protocols, health-promotion activities and programs, disease management and prevention, clinical decision-making, and patient education.

Respiratory therapists have further expanded their scope of practice through vent management techniques, which can be a life-saving intervention in the emergency department. Traditionally, RTs receive a patient in the ICU and place him on this method of intubation. They then practice institutionally specific therapies that can utilize albuterol and acetylcysteine treatments, provide aggressive recruitment, or deliver maintenance breaths to assist patients in need.

"Disease management is another area that RTs have expanded into, to insure readmissions by asthma and COPD are minimized due to the stiff penalties that providers may face from the recently passed Affordable Care Act," further explained Khan. "In the ICU, RTs are playing a more active role in determining ideal parameters to insure optimum ventilator support, and engaging with physicians and nurse teams for improved outcomes."

Dealing with ventilator needs in patients is extremely challenging because demand tends to outpace supply due to many patients not being eligible for organ donation. Furthermore, a prolonged decision by families on whether or not to approve a transplant can decrease organ availability, especially in the case of lungs.


Within hospitals, the RTs specifically provide care and life support to patients in the emergency room, intensive care units, general hospital areas, pulmonary diagnostics laboratory and other specialty areas such as rehabilitation. Also, because there are over 100,000 candidates waiting for transplants to date, RTs must work to maintain, use, and manage many types of equipment and administer a variety of necessary medications.

Other demanding responsibilities related to patient care include managing life-support mechanical ventilation systems, administering aerosol-based medications, monitoring equipment related to cardiopulmonary therapy, and analyzing blood samples to determine levels of oxygen and other gases.

Tasks such as managing artificial airways, assessing lung capacity to determine impairment, analyzing chest X-rays and sputum specimens, evaluating vital signs, performing tests and studies related to the cardiopulmonary system, conducting rehabilitation activities, counseling and consulting patients, are also carried out by RTs, according to Respiratory Therapist License. 

Due to such high demand, partially as a result of an aging population, RT departments are being called upon to continue bringing their value and profound impact into these hospital settings. Addressing lung disease and pulmonary diagnostics are at the forefront of many of healthcare's most important and immediate goals and challenges.

Lindsey Nolen is a former staff writer at ADVANCE.

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