Expanding the Concept of Missed Care Outside Nursing: Exploring Perceptions of Respiratory Therapists on Missed Care, Workload, and Assignments

Background: The COVID-19 pandemic had significant and lasting financial and resource impacts on hospitals and their respiratory care staff, including voluntary and involuntary staffing reduction. Despite rising patient acuity post-pandemic, requiring more complex care, hospitals remain challenged to rebuild permanent staff, continuing to work understaffed, which can lead to missed respiratory care. Missed care, or ‘care left undone’, is a well-researched concept in nursing, but evidence in respiratory therapy is limited. Methods: A cross-sectional survey was administered at two time points to staff RTs in an academic medical center and its associated community hospital campus. The survey aimed to identify staff perceptions about the types of/reasons for missed respiratory care, workload, and assignments. Descriptive statistics, (eg, frequency, mean, and median) were used to describe survey respondents; an independent samples t-test was used to compare differences between the survey time points. Timed studies were also completed during this project (daily vent rounds, rapid response, patient transport) to validate AARC standards for productivity management. IRB status deemed exempt. Results: Missed care was reported by 80% of RTs surveyed. Most frequent activities missed: timeliness in giving scheduled medications, pre and post treatment vital signs, focused reassessment and required documentation. The top 3 reasons for missed care: labor, inequitable assignments, and unavailable medications. Understaffing is associated with adverse patient and staff outcomes, and hospital revenue loss. Many staff reported end of shift exhaustion, a harbinger of burnout. Conclusions: The Missed Care Nursing Model is appropriate for use in respiratory care. The probability of missed respiratory care can be reduced by mitigating structural problems in the team, unit, and organization. Further study of the respiratory care work environment is needed to understand differences between teams, shifts, and service areas to address and prevent burnout, increase job satisfaction, create assignment equity, and improve patient, staff, and hospital finance outcomes. Supporting strong, healthy, and well-staffed respiratory care teams will improve care quality and all-around outcomes. Integration of evidence-based RVU-based productivity tools for all clinical activities should be considered in hospital financial management systems to justify/predict labor needs based on actual work, patient census, and care complexity trends.The Missed Nursing Care Model Reproduced from Kalisch, B. J. (2015)Most Frequent Types and Reasons for Missed Care