The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Sandra Hooper1, Sherry Seitz1, Dottie Biggar1, Cheryl Hoerr1, Darnetta Clinkscale1, E. Trulock2

Background: Our Pulmonary Rehabilitation population consists primarily of patients in our lung transplant program. When physicians began referring increased numbers of patients with COPD our ability to efficiently admit them was challenged. The resulting delay in starting the program was a contributing factor in both patient and physician dissatisfaction. With the hospital's stated objective to provide easy access and a high quality experience for both patients and referring physicians, the decision was made to streamline entry for patients with COPD.

Materials and Methods: A recent physician satisfaction survey indicated referring physicians were unhappy with the delays admitting their patients with COPD into the program. Average wait time from referral to start date was calculated for the previous 6 months. Reasons for delays in starting the program were also investigated. Results were reviewed and used as the basis for development and implementation of a plan to decrease the wait time to admission. A conservative goal was set to reduce wait time 10% within 12 months.

Results: Prior to implementation, average wait from referral to start date was 14.7 days (range 1-35 days). Barriers to starting the program included a lack of required documentation (history, physical, pulmonary function tests), patient illness, transportation problems and limited space available in the program. A plan was implemented to address identified issues. When a referral is received a therapist reviews and enters the information into a database within 8 hours and includes a note regarding missing information. This database is reviewed on a daily basis to ensure timely patient progression. Patients are contacted with 24-48 hours to confirm the order, be introduced to the program and be given a potential start date based on space availability and completion of required documentation from the referring physician. The physician is contacted with a detailed list of the documentation that is needed. Patients with transportation issues are referred to local agencies that provide transportation to the hospital. Following implementation the average wait from referral to start of the program is 10.25 days (range 5-21 days). Wait time has been reduced by 30%.

Conclusion: A structured admission process can reduce wait time for patients with COPD referred to an outpatient pulmonary rehabilitation program.