The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

REDUCING LENGTH OF STAY AND IMPROVING NET MARGIN IN COPD PATIENTS

Joy K. Hargett1, John S. Sabo1, Elizabeth Bearden1, Mary Curnyn1, Elena Ruocco3, Patsy Sellers2, Deborah Thompson2; 1Respiratory Care, St. Luke’s Episcopal Hospital, Houston, TX; 2Division of Nursing, St. Luke’s Episcopal Hospital, Houston, TX; 3Center for Advanced Clinical Practice, St. Luke’s Episcopal Hospital, Houston, TX

BACKGROUND: COPD patients represent challenges in cost of care and length of stay (LOS). METHOD: Facilitated by the Director of Respiratory Care, a team of RRT’s, RN’s, case managers, social workers, and pharmacists was developed to address these issues. We focused on streamlining performance and process improvement with physician input as required. We started with DRG 88 and development of a Pulmonary Unit. The Pulmonary Unit is the primary admission point for patients with COPD or other pulmonary issues and includes telemetry beds. A 6 hour training program was developed and taught by RRT’s, advanced practice nurses, and pharmacists for unit employees (RN’s, RN assistants, social workers, and case managers). A “pull” process which identified COPD patients early in the hospitalization facilitated a patient’s admission to the pulmonary unit. The COPD pathway designed to provide quality yet efficient patient care was re-vitalized and instituted on newly admitted COPD patients. Input from the physicians included the development of a 60 second “walk test,” patterned after the traditional 6 minute walk test. This procedure was designed to see how patients functioned in limited areas similar to the home environment. The Pulmonary unit opened in the late 2008. Due to patient census and bed availability, not all pulmonary patients are admitted to the pulmonary unit. RESULTS: In 2009, a comparison was made between DRG 88 patients admitted to the pulmonary unit and those who had been admitted elsewhere in the facility (non ICU patients only). With a comparable severity of illness defined by the MS DRG, patients admitted to the pulmonary unit had shortened LOS (5 %) and a considerable improvement in net margin (96%), as shown below. We attribute successes to caregiver training, focus on the pulmonary patient and improved practices, such as the pathway and earlier identified discharge needs. To solidify efforts, an advanced role for RRT’s, the Respiratory Clinical Specialist was implemented in June 2009. Duties include facilitating /streamlining the care of COPD patients by defining appropriate care, early discharge needs identification, case managing frequently admitted patients, and discharge follow-ups. This role will be evaluated to see if our positive results can be hardwired into daily clinical practice. CONCLUSION: Process improvement, commitment by all vested parties, and use of a COPD pathway can help reduce LOS and improve net margin. Sponsored Research - None

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