The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


John Sabo, Joy K. Hargett, Doug Wheeler, Margie Doty, Elizabeth Bearden, Mary Curnyn; Respiratory Care, St. Luke’s Episcopal Hospital, Houston, TX

Introduction: UHC benchmark data indicated opportunities for improvement in cost/case and LOS for COPD (DRG 88) patients. A multidisciplinary team addressed this and developed a strategic patient care unit to house these patients, called the Acute Pulmonary Unit (APU). The APU goal was to reduce length of stay (LOS) and improve net margin in hospitalized COPD patients while maintaining/improving quality. An integral part of the APU is the Respiratory Clinical Specialist (RCS). Method: The RCS is an advanced RRT position whose duties include facilitating care of the COPD patient with physician rounding, patient/caregiver teaching, defining appropriate care/discharge needs, and case managing those patients with frequent readmissions. In this “traffic cop” role, the RCS helps insure established patient care activities are occurring on a daily basis in the care of COPD patients. One activity is the 60-second walk, a procedure designed to give a real-life view of how patients tolerate mobilization in limited spaces, such as the home. COPD patients who may be admitted to the ICU care are seen by the RCS in order to facilitate transfer to the APU. The RCS will assist facilitate discharge issues between the patient, physician and durable medical equipment company and provide telephone follow up after discharge. The RCS role has recently expanded into the Respiratory Care Department’s inpatient sleep assessment program by helping identify high risk or diagnosed obstructive sleep apnea patients and facilitating orders for care. Results: An analysis compared FY2008 vs. FY2009 COPD (DRG 88) patient discharges. The result from FY2008 to FY2009 was a 9% decrease in LOS, a 7% decrease in total cost/case with an increase in CMI of 3%. Further analysis compared patients without an ICU/PCU admission who were admitted/discharged from the APU. The APU COPD patient population compared to non APU COPD realized a 2% decrease in LOS, a 9% decrease in cost/case with same CMI. Creating an “Alternative Care Level” for COPD patients resulted in a 23% decreased in COPD ICU admissions. COPD discharge from the APU after an ICU admission had a 32% shorter LOS with 27% less total cost/case than a COPD discharged from other areas. Conclusions: This initiative contributed improvements in average net margin/case of COPD patients from FY2008 vs. FY2009 of 32%. The RCS program has helped hardwire care, establishing the position as integral part of COPD management at our institution. Sponsored Research - None DRG 88 January - December