SHM Converge Scientific Abstract ePoster Gallery-Inpatient Multidisciplinary Process to Improve Aecopd Outcomes

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This inpatient multidisciplinary quality improvement project at the Cleveland VA Medical Center aimed to reduce admissions for acute exacerbations of COPD (AECOPD) and improve care processes aligned with GOLD guidelines. The team included hospitalists, pulmonology, pulmonary nurse practitioners, and inpatient pharmacists.<br /><br />The intervention had two stages. First, pulmonary nurse practitioner consultation was added to help guide inpatient management, create EHR notes, and support rescue pack prescribing. Second, inpatient pharmacy consultation was added to provide inhaler and medication education before discharge. The team used a dashboard to identify AECOPD admissions and encouraged treating providers to use the interventions.<br /><br />Baseline review covered admissions from September 2019 to October 2021, with chart review focused on July 2020 to January 2021 for follow-up and readmission outcomes. The project found that AECOPD admissions decreased from a pre-pandemic average of 20.3 per month to 11.8 per month after the pandemic began and did not return to pre-COVID levels. However, the primary aim of achieving a statistically significant reduction in AECOPD admissions was not met.<br /><br />A key process measure improved substantially: 12-week post-discharge pulmonary follow-up increased from 35% pre-intervention to 70% post-intervention, with p = 0.001. Pulmonary NP consultation occurred for 50 of 84 patients (59.5%). Inhaler teaching was provided to a majority of patients, and follow-up with pulmonology doubled after the intervention, but these changes did not show clear effects on utilization outcomes. Readmission reduction was not statistically significant (p = 0.48).<br /><br />The authors suspect that COVID-related precautions and increased home disease management contributed to the lower admission rates. They plan to continue multidisciplinary efforts, improve direct pharmacy notification for admissions, and reassess quarterly, especially after the new EHR implementation to optimize order set usability.

Asset Subtitle

Paul M. Shaniuk

Meta Tag

Author List Byschelle Jesberger, Joanne McKell, Paul M. Shaniuk, Rob M. Patrick, Sean W. Kim, Tonnette Jones-Ollison

Category Innovations

Concept COPD Exacerbation

Concept Multidisciplinary Inpatient Management

Concept Pulmonary Follow-up

Concept Pulmonary Nurse Practitioner Consultation

Concept Rescue Pack Prescribing

Distinguished Non-Finalist

Presenter Organization VA Northeast Ohio Healthcare System

Presenting Author Paul M. Shaniuk

Track Quality Improvement

Keywords

COPD

AECOPD

quality improvement

multidisciplinary care

pulmonology

pharmacy consultation

GOLD guidelines

hospital readmission

pulmonary follow-up

Cleveland VA Medical Center

COPD Exacerbation

Multidisciplinary Inpatient Management

Pulmonary Follow-up

Pulmonary Nurse Practitioner Consultation

Rescue Pack Prescribing