• Karen D LaRoché, Carl R Hinkson, Brett A Thomazin, Paula K Minton-Foltz, and David J Carlbom.
• Respiratory Care Department klaroche@uw.edu.
• Respir Care. 2016 Sep 1; 61 (9): 1137-43.

BackgroundIn the United States, care for COPD patients is frequently delivered by respiratory therapists (RTs). After implementing a therapist-driven protocol for COPD treatment, we sought to improve identification of COPD patients. We hypothesized that using an electronic medical record screening tool to identify subjects with COPD combined with a therapist-driven protocol would positively impact length of stay (LOS) and readmission rates.MethodsUtilizing the electronic medical record to search the provider's admission notes for the terms COPD/Asthma, a report was generated. Subjects already receiving RT services were removed. An RT evaluated identified subjects using a therapist-driven protocol combining clinical assessment and FEV1 to calculate an air-flow obstruction score. Scores ≥7 received 24 h of bronchodilator therapy by RTs. Scores <7 received assessment by RTs but bronchodilator therapy administered by nursing staff. An RT performed medication reconciliation and education for both groups. ICD-9 discharge codes identified primary and secondary diagnoses of COPD. LOS and 30-d readmission rates were measured for a 14-month period. Respiratory-triggered rapid response data were also collected.ResultsThe pre-intervention period was from December 2013 to June 2014, and the post-intervention period was from July 2014 to January 2015. There were 142 subjects in total, 68 pre-intervention and 74 post-intervention. For primary COPD, mean LOS decreased from 4.37 to 2.96 d (P = .10), and 30-d readmission rates decreased from 13.6 to 6.1%. Respiratory-triggered rapid response data were as follows: The pre-intervention span was from January 2014 to June 2014, and post-intervention was from July 2014 to December 2015. For primary COPD, there were 61 pre-intervention subjects and 63 post-intervention with a decrease in respiratory-triggered rapid responses from 21 pre-intervention (34.4%) to 8 post-intervention (12.7%) (P = .004). For secondary COPD (1,168 pre-intervention, 1,267 post-intervention), there was a change from 318 (27.2%) pre-intervention to 296 (23.4%) post-intervention (P = .03).ConclusionUtilization of the electronic medical record to identify subjects with likely COPD combined with a therapist-driven protocol directed by RT assessment was associated with a trend toward decreased LOS and reduction in readmission rates. There was a significant reduction of respiratory-triggered rapid responses in subjects with a primary diagnosis of COPD.Copyright © 2016 by Daedalus Enterprises.

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