The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

IMPACT OF COPD CARE PLAN ON READMISSION RATES AND LENGTH OF STAY.

F. R. Busta1, J. E. Martin1


BACKGROUND: Since 1995 a Therapist Driven Protocol has been used in the MetroHealth System.  In July 2003 the program was updated and expanded to include a care path for COPD patients.  The care plan was developed using the Gold Standards. The creation and education was completed using a multi-disciplinary approach. The care plan includes labs (blood, sputum), tests (chest x-ray, ECG), medications or vaccinations specific to the patients needs.  Patient education and respiratory therapist recommendations for discharge medications are required.  There is a standing discharge order for a home oxygen evaluation and referrals to pulmonary rehabilitation and smoking cessation classes. The second year that the care plan was in place, a clinical specialist position was created to oversee the care plans by following the patients daily, monitoring compliance, educating and implementing process improvement. We wanted to determine if there was any difference in the readmission rate or length of stay in our COPD patients after the implementation of the care plan and Clinical Specialist intervention.

METHOD A report was requested that listed all patients discharged with a diagnosis of COPD for the three time periods being studied. The first time period (Pre protocol) was the year prior to the implementation of the COPD care plan. The second time period (Protocol Year 1) was the first year that the protocol was in place. The third time period (Protocol Year 2) was the second year after implementation and the time period that the clinical specialist was in place. From the reports requested we were able to determine the number of patients admitted per month, how many had readmissions throughout the year, the total number of readmissions per year per patient, and the length of stay in hours.

RESULTS: In the pre protocol year there were 363 patients discharged with a diagnosis of COPD. There were 200 readmissions (55%).  The average length of stay was 93.3 hours. Protocol Year One showed 308 patients discharged with 161 readmissions (52%), and an average LOS of 82.1 hours.  Protocol Year Two showed 304 patients discharged with 136 readmissions (45%), and an average LOS of 73.9 hours.

 

CONCLUSION The data shows a decrease in the readmission rates and LOS in both Protocol time periods.There is a decrease in LOS by approximately 24 hours from the Pre protocol data to the end of Protocol Year 2. Monitoring will continue to determine if these favorable trends continue



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