May 2002 / Volume 47 / Number 5 / Page 578
Bedside Spirometry in a Tertiary Care Hospital: The Cleveland Clinic Experience
BACKGROUND: In contrast to outpatient, laboratory testing, which is performed by a small, dedicated group of pulmonary function technologists, inpatient, bedside spirometry at the Cleveland Clinic Hospital is performed less frequently and by a larger group of respiratory therapists with broader responsibilities. A 1998 audit of bedside spirometry tests at our hospital showed that American Thoracic Society acceptability and reproducibility criteria were infrequently met (15% of instances). METHODS: To address that shortcoming, we initiated an improvement plan for bedside spirometry that included: (1) A didactic review of American Thoracic Society acceptability and reproducibility criteria that was videotaped and reviewed by all but one of the therapists performing spirometry; (2) limiting the number of operators to a "core group" to allow more tests per therapist; (3) producing printouts of the pulmonary function tests, which allows immediate review of volume-time and flow-volume curves; (4) central review of all tests by a pulmonary function technologist and feedback and constructive suggestions on test quality and reproducibility to operators. After initiating the program we performed a consecutive survey of all inpatient spirometry sessions performed from July 16, 1998, to March 2, 1999. RESULTS: During the survey period, 63.5% of the tests (n = 137) were deemed acceptable, exceeding the low baseline rate of 15% (p < 0.001). Values for forced expiratory volume in the first second were reproducible in 83.9% of sessions. Values for forced vital capacity were reproducible in 80.3% of sessions. CONCLUSION: A quality improvement program for bedside spirometry testing that emphasizes training and routine feedback on test quality can enhance the quality of inpatient spirometry testing.
Key words: bedside spirometry, quality, pulmonary function testing, acceptability, inpatient.
[Respir Care 2002;47(5):578–582]
Although spirometry is an important test that is performed frequently for outpatient assessment in both general and specialty practice and in research, inpatient applications are more limited. Nonetheless, experience at our 1,000-bed tertiary care center suggests that bedside spirometry is performed frequently in hospitalized patients and that, depending on the indication, the results may impact the patient's short-term management. As with all clinical tests, emphasis must be placed on assuring high quality testing so as to avoid interpretive and management errors resulting from technically flawed results.
See the Related Editorial on Page 570
In the context of an ongoing interest in enhancing spirometry performance, we sought to evaluate the frequency, indications for, and performance quality of bedside spirometry in our hospital. Specifically, as part of a program to assure high-quality bedside spirometry, we undertook a prospective evaluation of consecutive bedside spirograms in order to address several questions:
- What is the total frequency of inpatient spirometry and what percentage of all inpatient tests require bedside performance?
- What is the overall quality of bedside spirograms, based on American Thoracic Society standards5 for spirometry testing?
- What is the impact of a program to examine and enhance the quality of bedside spirometry?
- Is there evidence of a threshold number of tests performed per technician to assure high quality?