Chronic obstructive pulmonary disease (COPD) is a major public health problem. The Global Burden of Disease Study has projected that COPD will become the third‐leading cause of death worldwide by 2020. In developed countries, COPD exacerbations account for the greatest burden in the health care system, costing the United States billions of dollars annually. The hospitalist group 30‐day COPD readmit rate for 2011 was 23.42%; this is similar to the national average rate of 22.6% for 30‐day COPD readmissions, according to the National Quality Forum Pulmonary Project.
To reduce 30‐day hospitalist readmissions for patients admitted with a diagnosis of COPD exacerbation by 10%, from January 2012 to December 2012
A retrospective chart review of patients readmitted with COPD exacerbation in 2011 was conducted to analyze reasons for readmissions. Some of the contributing factors for readmissions were lack of follow‐up, noncompliance with medical management plans, untreated psychiatric conditions, and lack of goals of care discussion. It was discovered that some of the charts were also coded inappropriately as COPD readmits. The patients were identified by the admitting hospitalist and included new patients from the emergency department or intensive care unit transfers. This information was then entered into a database. A “checklist” was devised to help standardize care for the patients admitted to the hospitalist service with COPD exacerbation. This entailed pulmonary consultation for patients to establish better continuity and offer standardized care, as well as to see if they would benefit from pulmonary rehabilitation on discharge. Usage of the COPD order set was also encouraged, but because of technical issues, general order sets were used. We used the PHQ‐9 screen for depression, and when appropriate, psychiatric consultation was obtained. The hospitalist ensured that follow‐up appointments were made within a week of discharge, either with patient's primary care doctor or pulmonologist, and verbal sign‐out was also given to the provider. Seventy‐two hours postdischarge, the hospitalist would call the patient to inquire about their condition, educate regarding worsening COPD symptoms, medication compliance, and stress the importance of keeping the follow‐up appointment. A COPD video was also shown to the patient by the nurses, as part of an institution‐wide education protocol. For all of 2011, there were 158 discharges with a diagnosis of COPD, with a 30‐day readmit rate 23.42%. From January to July 2012, there were 71 discharges with a diagnosis of COPD, with a 30‐day readmit rate of 19.7%
Our rate of readmission decreased by 16% because of better discussions regarding goals of care, more accurate documentation, and ensuring proper follow‐up after hospital discharge.
To cite this abstract:Gulipelli S, Bircaj A, Joasil P, Harisingani R. Copd 30‐Day Readmission Reduction Initiative. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 184. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/copd-30day-readmission-reduction-initiative/. Accessed April 21, 2019.