The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

EVALUATION OF THE EFFICACY OF A SCREENING PROCESS TO AVOID UNNECESSARY ORDERS FOR HOME OXYGEN ASSESSMENT

Dorothy G. Biggar1, Patricia Nellis2, Darnetta Clinkscale1; 1Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO; 2Physical Therapy, Barnes-Jewish Hospital, St. Louis, MO

Background: Inpatients anticipated to require home oxygen must be assessed using specific criteria indicating medical necessity for Medicare coverage. Test results must be documented within a 48 hour window prior to discharge. At our hospital this process was problem prone and resulted in a significant incidence of unnecessary orders. Prior to September 2008, the testing was shared by Pulmonary Rehabilitation and Physical Therapy. Confusion occurred as to whom nursing divisions should call. Upon going to the floor to test the patient, the patients often were unable to walk during the assessment, it was discovered the wrong test had been ordered or the wrong department had been notified of the order. This confusing process resulted in unnecessary work (ordering a test on a patient who cannot perform the test) or re-work (performing test twice since it was ordered outside of acceptable 48 hour window). Materials and Methods: In order to clarify and improve the process in Sept., 2008, Pulmonary Rehabilitation took full responsibility for the inpatient home oxygen assessment. In October, 2009 Pulmonary Rehabilitation staff began a screening phone call process to eliminate unnecessary orders prior to going to the patient care unit. Criteria used in the screening included: discharge within 48 hours and patient’s ability to walk. All calls were entered into a data base. Results: Comparison of overall rate from Period 2 (post intervention order screening process) to Period 1 (pre intervention prior to screening tool) shows a statistically significant difference (p=.024; 2 proportion test) in the rate of unnecessary calls for non-indicated tests. Conclusion: Implementation of screening tool for Home Oxygen Assessment appears to be effective in decreasing the rate of unnecessary calls. Sponsored Research - None

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