The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

THE PULMONARY INITIATIVE – A MODEL FOR REDUCING LENGTH OF STAY AND REDUCING COST/CASE IN COPD PATIENTS.

Joy K. Hargett, John S. Sabo, Margie Doty, Douglas Wheeler; Respiratory Care, St. Luke’s Episcopal Hospital, Houston, TX

Background and Method: UHC benchmark data indicated opportunities for improvement in cost/case and length of stay (LOS) for COPD (DRG 88) patients. A multidisciplinary team was formed which developed the strategic objective of improving or maintaining safe, quality care while improving financial outcomes. Utilizing the LEAN performance improvement methodology, the team identified the problem, current situation, benchmark standard, discrepancy, and potential causes. An analysis of the root causes was performed. Defined were short and long term countermeasures with specific responsibilities, expectations, and timelines. These were utilized to evaluate the success of the plan. A primary component of the Pulmonary Initiative was the development of the Acute Pulmonary Unit (APU). The APU which included telemetry and remote pulse oximetry technology became the primary admission area for COPD or other pulmonary patients. Other elements included staff education program, scope of service criteria, “pull” process identifying COPD patients early in their hospitalization to facilitate admission or transfer to the APU, revitalization of the COPD pathway and order sets, development of a “60 second walk test,” which evaluated patient functionality in limited spaces similar to the home environment and an advanced role for respiratory therapists, called the Respiratory Clinical Specialist (RCS). RCS duties included facilitating/streamlining care with other professionals, performing patient/caregiver teaching, defining appropriate care/discharge needs, follow-up after discharge, and case managing those patients with frequent readmissions. Results: An analysis compared FY2008 - FY2011 for COPD (DRG 88) patient discharges and is shown in the table. The Pulmonary Initiative produced shortened LOS and a decreased cost/case resulting in considerable financial improvement. Conclusion: With a 20% increase in the number of patient cases, this team was able to positively impact hospital financial margins. Our strategy and process allowed us to achieve a positive net margin of 53% in 4 years. In the 4th quarter of 2011, we implemented a discharge phone call process and saw a dramatic decrease in the 30 day readmission rate to 2.4% in the 1st quarter of 2012. We believe our organized approach and not one particular factor has contributed to the overall success of this initiative. Sponsored Research - None