COPD 30 Day Readmission Project SAINT THOMAS RUTHERFORD MURFREESBORO, TN SEPTEMBER 15, 2015 DAVID M. SELLERS, MD, MBA

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1 COPD 30 Day Readmission Project SAINT THOMAS RUTHERFORD MURFREESBORO, TN SEPTEMBER 15, 2015 DAVID M. SELLERS, MD, MBA

2 USA COPD Data 24 Million Americans under the age of 65 with COPD Almost 20% readmit within a 30 day window From a payer perspective, the cost of care is an average of $7,500 per admission 99% of COPD patients attending Pulmonary Rehabilitation do not readmit within 30 days *AARC Times July 2015 Vol.39, Issue 7

3 Saint Thomas Rutherford Baseline 30 day readmission rate of 22% for COPD patients January 2015 after possible causes of COPD 30 day readmissions identified changes were started to be implemented The focused committee charged with improving COPD readmission rates meets weekly and continues to modify processes as hurdles are discovered

4 Reasons Identified For COPD Readmissions Poor pre-discharge planning Inadequate communication to out-patient providers Inadequate medication/safety education Patient education that is not taught at the patient or caregiver s level of health literacy Poor handoff Poor post-discharge communication with patient/caregiver (often this is communication with the durable medical equipment supplier). Delay in Pulmonary Rehabilitation registration/acceptance into STHR Pulmonary Rehabilitation Program

5 Poor Pre-discharge Planning Respiratory case management identifies from the beginning of hospital stay: Educates new patients for about one hour seeing what patient knows and needs to know about their disease as well as what is needed at discharge. Starts educating about pulm rehab. Hospitalists treats patient and also educates about the benefits of pulm rehab should patient qualify for it. Assesses patient for discharge needs. On last hospital day Hospitalists orders bedside spirometry If patient qualifies PCP is sent order to initiate patient into pulm rehab

6 Inadequate Communication To PCPs If pulm rehab needed PCP given letter with spirometry results and recommendation to sign order for pulm rehab E-newsletter sent out to entire medical staff explaining our COPD initiative. Stones River IPA PCP meeting attended and COPD initiative at the hospital reviewed. Hospitalists partnered with the Saint Thomas Alliance to visit PCP s and continue and reinforce the COPD initiative.

7 Inadequate Medication/Safety Education Respiratory case management teaches and reinforces education on medications. Reinforced information given with COPD/Pneumonia booklet that is reviewed with patient by the nursing staff and pharmacists

8 Poor Handoffs Hospitalists and Respiratory case managers provide communication to PCP. Patient educated with an easy to follow handout when to be concerned with breathing and when to escalate concern to PCP vs ED. For appropriate patients who use need non-invasive respiratory support we use preferred vendors who teach in the home with respiratory therapist and communicate very well with PCPs. When SNF needed for patient we have partnered with the facilities that use our recommendations for COPD treatment and also partner with companies who provide respiratory therapist to help with rehab and teaching.

9 Poor Handoffs Respiratory Case Management: Gives patient follow up call hours, then weekly until 31 days out Maintains extensive spreadsheet of COPD patients documenting the entire process including follow up with outpatient pulm rehab

10 Delay in Pulm Rehab registration/acceptance Inpatient Respiratory case management now: Gets order from PCP Gets patient financially approved if necessary or approved on insurance Provides initial evaluation for proper placement into rehab class Assigns patient their first class

11 Lead Indicators For Improvement Bedside PFT appropriately ordered Qualifying pts receive a pulm rehab referral Pt referred successfully starts and finishes rehab

12 COPD Cases Including Readmits day Readmits Non 30 day Readmits Oct Nov Dec Jan Feb Mar April May June

13 120 Lead Indicators By Percent FEV1 ordered Rehab Refer Enroll in Reb 20 0 Feb March April May June July

14 Respiratory Rhonda

15 Pulmonary Rehab

16 Successes Currently: 30% of all of the Pulmonary Rehab patients are from the COPD Readmission Prevention Team- vs 2014 thru September 2015 only 2 former in-house patients were admitted into the Pulmonary Rehab program. Addition of another class (3 rd ), opened in Pulmonary Rehab due to volume from Pulmonary Rehab Prevention Team- Need for (4 th ) class for the month of September to meet the demands. Zero Pulmonary Rehab patients have readmitted in 30 Days!!! Thank you from the Pulmonary Readmission Team!