The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Gary Brown; Respiratory Care, Sanford Medical Center, Fargo, ND

BACKGROUND: The costs associated with providing hospital care to patients admitted with a COPD exacerbation is a growing concern nationwide. We decided to review our processes of providing inpatient COPD care and compare them to recently published adherence data with evidence-based guidelines1 (recommended care) to identify areas where we might improve outcomes. We also sought to determine the degree to which non-recommended care was prescribed in our facility. METHODS/MATERIALS: An audit of our processes of COPD care revealed that significant variance existed between the prevalence of our use of recommended care and recently published adherence data. In 2008, under the auspices of a multidisciplinary improvement team, we developed and implemented a novel Inpatient COPD Care Program intended to bring our care processes more in-line with published performance criteria. Our COPD Care Program consists of four inter-related components: (1) Development of a COPD Standing Order Set; (2) Development of a respiratory therapist (RT) directed COPD Medication Protocol; (3) Creation and use of RT Clinical Specialists to oversee and provide COPD care, and (4) Monitoring of selected clinical and economic outcomes. RESULTS: After one year, our prevalence of recommended care for COPD inpatients increased from 57% to 71%, surpassing the national mean of 68%. Further, our prevalence of non-recommended care decreased from 36% to 34%, well below the national mean of 44%. Finally, our prevalence of ideal care (patients receiving all recommended care and no non-recommended care) increased from 34% to 49%, exceeding the national mean of 33%. We also observed that while the average length of stay for all COPD patients remained relatively unchanged and within the Medicare geometric mean, the actual cost per patient day decreased. This resulted in a net increase in the hospital's margin for this patient population. CONCLUSIONS: An innovative, RT-directed inpatient COPD Care Program can increase the application of evidence-based care guidelines and improve clinical and economic outcomes. CLINICAL IMPLICATIONS: Improving clinical outcomes of COPD inpatient care can reduce the financial burden for acute care hospitals of this growing and expensive chronic medical condition. 1. Lindenauer PK, Pekow P, Quality of care for patients hospitalized for acute exacerbations of COPD. Ann Intern Med, 2006; 144:894-903. Sponsored Research - None