The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

DECREASING THE READMISSION RATE AND ACUTE HOSPITAL LENGTH OF STAY FOR COPD PATIENTS (DRG ? 88): LUTHERAN HOSPITAL COPD COMMUNITY REINTEGRATION PROGRAM

Douglas S. Laher, BS, RRT, RCP, Lutheran Hospital, Cleveland, Oh

Background:  
Patients diagnosed with COPD and readmitted within 31 days of discharge with the same diagnosis impose significant financial burdens on Healthcare Institutions. These financial problems are compounded when coupled with an Acute Length of Stay (A.L.O.S.) that exceed the regional DRG benchmark of 3.4 days. The COPD population of Lutheran Hospital in Cleveland, Ohio (Cleveland Clinic Health System) had an A.L.O.S. of 4.2 days, exceeding the DRG benchmark by 0.8 days. In addition, the readmission rate for these patients with the same diagnosis was 13.2%. Fiscal and patient care accountability was mandated and the COPD Community Reintegration Program was developed.  

Methods: 
A comprehensive educational program was developed and implemented Feb. 17, 2003 on the sub-acute rehabilitation floor of Lutheran Hospital. This program, comprised of a multi-disciplinary team (Respiratory Therapy, Nursing, Social Service, Physical Therapy, Occupational Therapy, Pharmacy, Nutrition and Home Care) focused on educating the patient regarding their disease process in an effort to better prepare the patient to self diagnose and self manage their COPD once discharged to the home environment. Once admitted to the Acute Medical Nursing floor with a COPD diagnosis (DRG-88), the patient is monitored by the Case Manager to ensure 1 of 3 things takes place within 3 days of admission; (a) There is a clinical need for the patient to remain in the acute arena, (b) The patient is either discharged home or to another facility, or (c) The patient is enrolled into the sub-acute program. If after 3 days the patient is not appropriate for discharge, but meets specific admission criteria, the patient is automatically enrolled in the COPD Community Reintegration Program. 

RESULTS:
 Year to date, 22 COPD patients have been admitted to the COPD Community Reintegration Program. Of those patients, 9.2% (2) were readmitted to Lutheran Hospital within 31 days of discharge with the same COPD diagnosis (¯4.0%). In addition, the overall A.L.O.S. for these patients was 3.13 days (¯ 1.07 days and 0.27 days less than the DRG benchmark). This was at a significant cost savings to the hospital and reintegrated the patient back into the community more efficiently than what was historically performed at Lutheran Hospital. 

CONCLUSION:
 COPD patients who are at risk to exceed their DRG allocation of 3.4 days on the Acute Medical Floor and meet specific admission criteria are admitted to the sub-acute rehabilitation floor where they are enrolled into the COPD Community Reintegration Program. This program not only provides improved patient care by better preparing the patient to manage their disease once discharged from the hospital, but also provides significant fiscal savings to the hospital as evidence by the decrease readmission rate and A.L.O.S.  Key words: COPD, Lutheran Hospital, Acute Length of Stay, COPD Community Reintegration Program, Rehabilitation, Multi-Disciplinary Team, Cost Savings
 

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