A study published ahead of print by Hospital Topics on Oct. 17 found a COPD inpatient education program using existing respiratory therapy staff in an academic health system in Pennsylvania reduced hospital length of stay and associated costs.
AARC member Daniel Ofak, RRT, RRT-NPS, who recently took on a new job as director of respiratory therapy at Lehigh Valley Health Network in Allentown, PA, was a coauthor on the study. He explains how the program came about and the role RTs played in it in this interview —
When and why did the hospital decide to implement inpatient education for COPD patients and why were RTs selected as the clinicians to provide it?
We started offering a COPD education program for COPD inpatients in October 2014 after the Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP). COPD was among the six diagnoses addressed in the HRRP, which charged hospitals with reducing excessive 30-day readmission rates by improving quality of care. Our department director saw an opportunity for RTs to play a pivotal role in reducing readmissions and pulled together a team of RTs to evaluate and address gaps in care. Our nursing executive also supported this initiative, which gave the program legitimacy within the organization.
When and why did you decide to embark on the study to gauge the effectiveness of the program?
Approximately two years post program implementation, our hospital quality manager provided evidence that showed our RT COPD educators were making a difference reducing 30-day readmission rates for COPD patients. While discussing these outcomes with the program director of our graduate health administration program, we wondered if length of stay and health care costs were also being impacted by the work of the RTs, which led to a more detailed examination of the results.
You used existing staff to deliver the education — how did you work this additional obligation into your existing workload and how did your RTs respond to taking on this extra duty?
Experienced clinical RT leaders, who were familiar with the organization, were selected to deliver COPD patient education, which helped gain widespread support from staff. Supervisors and charge therapists also played an important role. During surges in patient census and increased acuity, supervisors and charge therapists were asked to exhaust alternative staffing options before pulling the COPD educators from their assignment.
The success of the program is owed to the COPD educators who spent hours with their patients, listening to their story, providing education around their disease and medications, and helping tailor a management strategy to reduce symptoms and improve quality of life. They collaborated with physicians, RNs, and other health care workers to address barriers to optimal care and ensure patients were ready for hospital discharge. They actively participated in continuous process improvement discussions to iron out workflow inefficiencies such as leveraging the electronic medical record to identify COPD patients upon admission, streamline documentation, and improve hand-off communication.
Their work ultimately helped reduce 30-day all-cause COPD readmissions, decreased length of stay, and reduced health care costs for the patients they educated. While successful, less than 15% of COPD inpatients received education during this time frame since we did not have dedicated respiratory therapists providing bedside education.
Would you recommend an intervention like this to your fellow RT managers? Why or why not?
I would recommend that managers/directors consider implementing a COPD education program. RTs with knowledge in chronic pulmonary disease management strategies may be able to help patients translate their health goals into actions and behaviors proven to manage symptoms, reduce exacerbations, and improve quality of life.
What are your top tips on successfully implementing a program like this?
There are probably more, but I recommend the following be considered:
- Garner support from your administrator prior to implementation. This will require, at a minimum, articulating the problem you’re trying to solve, why it’s important to solve it, and how you’ll know the intervention is successful. Depending on your hospital, a more detailed business plan may be needed.
- Set reasonable goals and focus the team around continuous learning and process improvement.
- Capture process and outcomes data to help identify program strengths and weaknesses to drive your improvement initiatives.
- Utilize high performers who can persevere through the challenges inherent to implementing a new program, such as delays, setbacks, staffing issues, etc., and who can remain focused on process improvement.
Thinking about implementing a COPD inpatient education program in your department?
The AARC’s Pulmonary Disease Educator Course can help prepare your RTs to take on the role.