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RELIABLE ADHERENCE TO BEST PRACTICES THAT MITIGATES SYSTEM-LEVEL ERRORS REDUCES COPD READMISSIONS: A SYSTEM REDESIGN USING IMPROVEMENT SCIENCE
  1. Muhammad Zafar1,
  2. Ralph Panos2,
  3. Eric Warm1,
  4. Evaline Alessandrini3
  1. 1University of Cincinnati Medical Center, United States
  2. 2Cincinnati Veterans Affairs Medical Center, United States
  3. 3Cincinnati Children's Hospital Medical Center, United States

Abstract

Background Although COPD readmissions adversely affect patient outcomes and health care costs, interventions that reduce readmissions have not been identified.

Setting University of Cincinnati Medical Center, a regional referral, safety net hospital.

Objectives

  1. Identify failures in care delivery for COPD patients readmitted within 30 days.

  2. Reduce COPD readmissions through system redesign.

Methods We performed a cross-sectional study of COPD 30-day readmissions from 10/2014–3/2015. Readmitted COPD patients were interviewed to identify needs at discharge. We reviewed published literature to identify best practices. We formed a multidisciplinary team to identify a 5-element COPD care bundle designed to mitigate system failures. “Model for Improvement” was used to redesign care delivery. Time-series analysis was performed using statistical process control (SPC) chart. Compliance to bundle components and all-cause 30-day readmissions were observed.

Results There were 52 readmissions among 31 patients. Median time to readmission was 7+7.9 days. COPD was the most common readmission diagnosis (55%), followed by CHF and pneumonia. 42 system-level failures were identified (figure 1). Patient interviews revealed lack of clarity about discharge instructions, including inhaler use. COPD care bundle comprised of; appropriate inhaler regimen, bedside inhaler education, 30-day supply of medications, follow-up within 15 days and standardized discharge instructions. Compliance to COPD care bundle improved over time approaching 90% reliability (figure 2). COPD 30-day all-cause readmission rate decreased from 22.7% to 14.79% with system shift on SPC chart (figure 3).

Conclusions System-level failures and unmet patient needs are modifiable risks for COPD readmissions. Using improvement science to mitigate institution specific system-level failures reduces COPD readmissions.

Figure 1

Identified system-level failures.

Figure 2

Compliance to care bundle.

Figure 3

All-cause readmission rate.

  • Accreditation
  • Anaesthesia
  • Attitudes

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