title: Impact of an Electronic Medical Record Screening Tool and Therapist-Driven Protocol on Length of Stay and Hospital Readmission for COPD.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  Utilizing 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  Utilization 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.
authors.affiliation: Respiratory Care Department klaroche@uw.edu.
authors.forename: Karen D
authors.initials: KD
authors.lastname: LaRoché
authors.affiliation: Respiratory Care Department.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Hinkson
authors.affiliation: Respiratory Care Department.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Thomazin
authors.affiliation: Patient Care Services Administration, Harborview Medical Center, Seattle, Washington.
authors.forename: Paula K
authors.initials: PK
authors.lastname: Minton-Foltz
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.
authors.forename: David J
authors.initials: DJ
authors.lastname: Carlbom
mesh_terms: D000465:Algorithms; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D057286:Electronic Health Records; D005541:Forced Expiratory Volume; D006801:Humans; D016247:Information Storage and Retrieval; D065186:Interrupted Time Series Analysis; D007902:Length of Stay / Q000639:trends; D059065:Medication Reconciliation; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; electronic medical record screening; therapist-driven protocol