Management’s Cornerpool of healthcare professionals. This makes was so frustrated by the end of it, that she justcompetition for those great employees very gave up and said to me…’oh forget it, whydifficult, hence why recruitment and retention would anyone want to work there if they makemust be made a priority in healthcare today. it so damn complicated and uncomfortable just to give them a resume, let alone if anyoneAs many of you are aware, the Ontario even reads what I’ve attached’. This multi-sitegovernment’s healthcare strategy is having hospital in Ontario, lost, what I consider to becare close to home as well as having the right an excellent potential employee, because ofcare, at the right time, in the right place. It’s the process they currently have in place, just toa bit more complex than this, but you get provide information.the picture. Along with this is the prevailingtrend of amalgamations of facilities and This is certainly a small example, and I knowtransitioning of care from acute to community. many of you reading this have been throughAll this is fine…again, having the right vision is her experience (as I have). I am simply tryingwonderful, and with so much change occurring to show that right from the beginning, we arein our healthcare system, you want (as the not doing a good job of recruitment, let alonelead of an organization) to recruit the right retention. We need healthcare organizations ofpeople. You want employees that believe in the all sizes to implement a variety of new processesvision and move forward with change, work and procedures, using human resourcewell in teams, give great care to patients, have departments together with their IT systems, tothe right attitude, give feedback to better the make onboarding of information or inputtingdepartment, etc. However, have any of you of resumes, call backs, hiring, interviews,been on these huge hospital conglomerate reference checking…modernized, simple, andwebsites? Have you tried to apply for a job? usable by all and most important, easy for the end user (the human resources employee) toJust as a test run, for this article, a friend extract what they require. We really do needof mine tried it (I won’t disclose either the to begin to think outside the proverbial box,hospital or the name of the applicant to protect to be creative and think of a new system fromprivacy) and this is what she found. It is not beginning to end, when we recruit talent intouser friendly, but is actually confusing; between an organization.attaching the resume and cover letter, whichare on separate pages, then you don’t know Once hired, the unit manager must continueif they have connected properly, because it to be ultimately responsible for retainingbegins asking you questions that your resume new employees. They know the job thatwould answer. Ultimately, you were completing needs to be done; they know the culturedouble the work in entering information. Then, of the organization, are aware of the teamat times, you could not get to the next page dynamics, and more importantly, know theand were not able to figure out what you did results that both the staff and the facility need.wrong to move forward…. on and on. She Managers are tasked with developing theirRTSO Airwaves - Winter 2017 Page 49
Management’s Cornerteam and transitioning them into expanded They show respect to all by treating them withjob responsibilities (when the time is right of concern and honesty. They show strength whencourse). The organization’s human resources required, to make the hard decisions. Now, Idepartment must also be responsible for didn’t say, showing leadership by commanddeveloping a retention strategy. This can and control, as that style should no longer beinclude various elements, such as: employee used; unfortunately, some managers in today’srecognition programs; internal advancement workforce continue to use this leadershipopportunities; mentoring; and advanced style. It doesn’t work and that particular typeeducation initiatives. There are various of manager will find themselves alone andstrategies, but they must be developed and frustrated with high staff turnover and theimplemented, not just talked about. inability to meet targets, or worse…they’ll have poor staff morale.Managers need to embrace that staff retentionis actually part of their role, even if they didn’t In conclusion, the recruitment and retention ofrealize it when they took on the ‘manager highly trained healthcare professionals is a dualjob’. Good managers are relationship builders, responsibility between the human resourcesable to nurture candidates for future internal department and management. The times arepositions; they use best practice when they changing, and we need to change along withtrain/orient the new hire to their positions to them; to be creative, to develop new processes --emphasize excellence in patient care. so that we are able to recruit and retain the best.“If you think you’re too small to be effective, you havenever been in bed with a mosquito” – Betty ReeseARI with NSAID Use Poses Increased Risk of MIAccording to a report published online February 1st in the Journal of Infectious Diseases,having an acute respiratory infection (ARI), coupled with using a nonsteroidal anti-inflammatory drug (NSAID), increases the risk for acute myocardial infarction (AMI) 3.4-fold if taken by mouth and 7.2-fold with parenteral dosing compared with baseline riskwithout NSAID use or ARI.Resource:J Infect Dis (2017) jiw603. DOI: https://doi.org/10.1093/infdis/jiw603Retrieved online 2017/02/06 from https://academic.oup.com/jid/article-abstract/doi/10.1093/infdis/jiw603/2965358/Acute-Respiratory-Infection-and-Use-ofPage 50 RTSO Airwaves - Winter 2017
Dear aRTee, I am hearing the acronym “ACOS” thrown around in our ICU as a new diagnosis in one of our well-known severe asthmatic patients. The intensivist said it refers to Asthma-COPD Overlap Syndrome, yet I have never heard of this in my practice. Does such a beast exist? ZedDear Zed, obstruction. The 2015 GOLD-GINA document includes ACOS and describes itAs you know, asthma and COPD are two as not a single disease but as “persistentof the most frequent chronic respiratory airflow limitation with several featuresdiseases we see in our practice. Although usually associated with asthma and severalthese diseases have different characteristics, features usually associated with COPD”, thatsome patients share features of both “includes patients with different forms ofdiseases, and this has been called “Asthma- airways disease (phenotypes).” (GINA-GOLDCOPD Overlap Syndrome (ACOS)” in recent 2015, p. 3). It is likely that for ACOS, asliterature and is now emerging as common for asthma and COPD, a range of differentlanguage in clinical practice. According underlying mechanisms will be identified forto the Lung Association (2017), most of each individual patient.the time asthma is diagnosed in childhoodbut it can also be diagnosed later in life, GINA-GOLD 2015 (p. 5) states, “There iswhereas COPD is mostly diagnosed in broad agreement that patients with featuresadults beyond the age of 40. of both asthma and COPD experience frequent exacerbations, have poor qualityCurrently there does not seem to be a of life, a more rapid decline in lunguniversally accepted definition of ACOS. function and high mortality, and consumeFrom a literature search, it was hypothesized a disproportionate amount of healthcareas early as 1961 (Postma & Raibe, 2015); resources than asthma or COPD alone.”an early definition from Gibson & Simpson(2009) described ACOS as symptoms of GOLD’s Asthma-COPD Overlap Syndromeincreased variability of airflow in association Guidelines provide a process for diagnosiswith an incompletely reversible airflow and management of ACOS. The publishedRTSO Airwaves - Winter 2017 Page 51
Ask aRTeeguidelines provide a stepwise approach provide information on the therapeuticwith details covered in additional tables. strategies. If asthma is the diagnosis,The following briefly summarizes the the GINA guidelines provide the plan5-step process: to manage this disease. If the diagnosis points to ACOS, the recommendation isStep 1: Does the patient have chronic to start therapy according to the asthmaairways disease? Screening questionnaires guidelines and at the appropriate step,coupled with the clinical history, physical reflecting the severity of the disease.examination and radiographic findings are This approach includes use of an inhaledused to determine next steps. corticosteroid (ICS) in a low to moderate dose and opens the possibility of addingStep 2: Examine the characteristics of a long-acting beta2agonist (LABA) ifthe patient’s presentation for distinct needed (the LABA should not be givenor overlapping features. In the ACOS as monotherapy but always combineddocument, asthma and COPD have their with an ICS). Treatment of ACOS shouldown set of features that describe disease also include the appropriate steps(for example, asthma: onset before age including smoking cessation, pulmonary20 years; COPD: onset after age 40 years) rehabilitation, vaccinations, and treatmentand each feature has a check box. There of co-morbid conditions.are 11 features for each disease, and threeor more features under one heading in Step 5: Referral for specializedthe absence of an alternative diagnosis investigations. Referral to an expert shouldpresents a high likelihood for the correct be made for patients who have persistentdiagnosis. When a similar number of symptoms or frequent exacerbationsfeatures are checked under both COPD after appropriate treatment has started,and asthma, the diagnosis of ACOS may or for patients who have not been clearlybe more likely. diagnosed. In ambiguous cases, further tests such as DLCO, ABG, high resolutionStep 3: Spirometry is essential. ACOS CT scan, atopy skin testing, bloodguidelines recommend spirometry tests for biomarkers such as fractionalbe performed at either the initial or exhaled nitric oxide (FeNO) and/or bloodsubsequent visit, if possible before and eosinophilia, and sputum analysis may beafter a trial of treatment.” Spirometry useful for proper diagnosis.is evaluated based on pre- and post-bronchodilator FEV1/FVC and FEV1% So yes, the beast is real. Postma & Raibepredicted. (2015, p. 1246) cite the “danger of seeing ACOS as a disease entity…that we mayStep 4: Commence initial therapy. If the blur the lines between asthma and COPD,diagnosis is COPD, the GOLD guidelines because studies addressing the patientPage 52 RTSO Airwaves - Winter 2017
Ask aRTeepopulation with ACOS specifically are The Lung Association (2017). Asthma-lacking” and they go on to state, “more COPD Overlap Syndrome (ACOS).research is needed to better characterize Retrieved online 2017/01/24 frompatients and to obtain a standardized http://www.on.lung.ca/january-2017-definition of ACOS that is based on spotlight-on-asthma---asthma-copd-markers that best predict treatment overlap-syndrome?response in individual patients”. Soundslike a great research opportunity! Additional readings: Louie S., Zeki A.A., Schivo, M., Chan A.L., Yoneda, K.Y., Avdalovic, M., et al.References (2013). The asthma-chronic obstructive pulmonary disease overlap syndrome:Gibson P.G. &Simpson J.L. (2009). The pharmacotherapeutic considerations.overlap syndrome of asthma and COPD: Expert Rev Clin Pharmacol. (2013),what are its features and how important is 6:197–219.it? Thorax (2009);64:728–35. Izquierdo-Alonso, J.L., Rodriguez-GINA-GOLD (2015). Diagnosis of disease Gonzálezmoro, .J.M, de Lucas-Ramos,of chronic airflow limitation: Asthma, COPD P., Unzueta, I., Ribera, X., Antón, E., et al.and asthma-COPD overlap syndrome (2013). Prevalence and characteristics(ACOS). Retrieved online 2017/01/20 of three clinical phenotypes of chronicfrom http://goldcopd.org/asthma- obstructive pulmonary disease (COPD).copd-asthma-copd-overlap-syndrome/ Respir Med. 2013;107:724–31.Postma, D.S. & Raibe, K.F. (2015). Papaiwannou, A., Zarogoulidis, P.,Review Article: The Asthma–COPD Porpodis, K., et al. (2014). Asthma-Overlap Syndrome. N Engl J Med chronic obstructive pulmonary2015;373:1241-9. (DOI: 10.1056/ disease overlap syndrome (ACOS):NEJMra1411863) Retrieved online current literature review J Thorac Dis2017/01/20 from http://dl.umsu.ac.ir/ 6(S1):S146-S151.bitstream/Hannan/64417/1/1241.pdf “Being a good listener is absolutely critical to being a good leader; you have to listen to the people who are on the front line.” - Richard BransonRTSO Airwaves - Winter 2017 Page 53
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