The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

IMPACT OF INPATIENT ASTHMA 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 Asthma patients.  The care plan was developed using the NIH Asthma Guidelines.Creation and education was completed using a multi-disciplinary approach.  The care plan includes options forlabs (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 flow volume loop and referral to smoking cessation classes.  The second year that the care plan was in place, a clinical specialist position was created to oversee the care plan 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 asthma patients after the implementation of the Asthma Care Plan and Clinical Specialist intervention. 

METHOD A report was requested that listed all inpatients with a primary diagnosis of Asthma for the three time periods being studied.The first time period (Pre protocol)was the year prior to the implementation of the Asthma 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 359 patients admitted with a primary diagnosis of asthma. There were 86 readmissions (24%)and the average length of stay (LOS) was 62.8 hours.  Protocol Year 1 showed an admission rate of 266 patients with 58 readmissions (22%) and the average LOS was 61.9 hours.  Protocol Year 2 showed an admission rate of 297 with 64 readmissions (22%) and the average LOS was 55.4 hours

CONCLUSION The data shows a slight decrease in LOS in Protocol Year 1. There was a greater decrease in LOS in Protocol Year 2 after Clinical Specialist intervention.  Monitoring will continue to determine if the respiratory therapy interventions will further reduce readmission rates and LOS.


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