Dr. Thomas Bice has received the Physician of the Year Award by the North Carolina Society for Respiratory Care. The award recognizes his efforts to coordinate the ROAD (Respiratory Optimization and Assistance for Discharge) Team at UNC Medical Center.
The precarious nature of the ICU and the physiology of airflow and gas exchange had always appealed to Dr. Thomas Bice as he considered his medical career. The Arizona native completed medical school at Tulane University School of Medicine in New Orleans and residency at the Mayo Clinic in Minnesota before becoming a pulmonary and critical care fellow in the UNC department of medicine. Just as he was transitioning from fellowship to faculty, he noticed a patient group that he thought could be better served.
“Most patients who require mechanical ventilation only need it temporarily, for 3-4 days,” said Dr. Thomas Bice, clinical instructor in the division of pulmonary diseases and critical care medicine. “But of all patients who do need it, 5-10% will require prolonged mechanical ventilation. I felt like they were subjected to many provider handoffs, averaging 40-50 days in the hospital.”
Dr. Bice found that patients who required prolonged mechanical ventilation – those needing ventilator support greater than 10-14 days – were frequently without a place to go. One option might be a long-term acute care (LTAC) facility, but for many patients – those with Medicaid, with private insurance without LTAC coverage, and those without insurance – LTAC is not an option.
While evaluating these patients, Bice saw they were exposed to one new nurse and one new respiratory therapist every day they were in the hospital. They were also passed from one physician to the next, with potential changes in their care plan at each step. With mounting pressures to manage costs for medically complex patients requiring extended stays, Bice believed there was a way to bring features of an LTAC to patients at UNC Medical Center.
Then the stars aligned. Bice met with Kathy Short, director of respiratory therapy at the time. She was working with the hospital complex care team to find ways to help patients with long hospitalizations. Bice saw that many of these patients were those he wanted to help. An interdisciplinary team could help coordinate care for these patients with complex respiratory needs.
“Dr. Bice organized members of the respiratory therapy department, nursing, care managers, dieticians, and rehab medicine to create a multidisciplinary team,” said Kathy Short. “It would help wean long term mechanically ventilated patients and find appropriate placement once they are optimized for discharge.”
Previously, all of these services would see these patients, but they may not talk to each other to coordinate care. Patients at UNC Medical Center are now benefiting from the coordination of care and some outside the box thinking of the Respiratory Optimization and Assistance for Discharge (or ROAD) Team. Most are now able to go home when they might not have been able to before.
“One patient couldn’t be free from BiPAP (bilevel positive airway pressure),” said Bice. “We couldn’t remove her tracheostomy – which could have enabled her to go to skilled nursing or LTAC – because insurance wouldn’t cover that discharge plan. We couldn’t arrange for her to go home with a regular ventilator, as insurance wouldn’t cover that either.”
But the patient’s insurance would cover a BiPAP machine through the trach, although not a common practice, and the patient agreed. Bice says this enabled her to go home after many months in the hospital.
“Before, a patient with this many complicated issues might have spent a significant amount of time in a skilled nursing facility, hoping their respiratory issues would resolve. Now, for the vast majority, we’ve been able to get these patients either liberated from the ventilator and discharged home, or discharged home with a ventilator. It’s been rewarding to see how quickly things have improved for these patients.”
The consult team meets every Monday to determine the best care plan for the week. As patient care is continually tracked, Bice hopes to find the team has shortened time in the hospital, and shifted much of the disposition to home, rather than skilled nursing, saving the system and patients money. After all, most patients want to find a way to return home.
On September 6, 2017, Dr. Thomas Bice was awarded the Physician of the Year Award by the North Carolina Society for Respiratory Care. The award recognized his efforts with the ROAD Team.
“He is a true advocate for the respiratory therapy profession,” said Kathy. “As a new pulmonologist at UNC Medical Center he has worked collaboratively with the respiratory therapy department to create positive outcomes for our patients.”