LESSONS LEARNED FROM MULTIDISCIPLINARY TEAM APPROACH TO TACKLING 30-DAY COPD READMISSIONS AT HARLEM HOSPITAL CENTER

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Chronic obstructive pulmonary disease (COPD) readmissions pose a significant burden on patients as well as hospitalization costs. Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for excess all cause readmissions within the 30 days following discharge. Between 10 to 20% of COPD patients are admitted within 30 days of discharge. Multidisciplinary team approach (MDT) has been proposed as a tool to reduce readmission, and was implemented at Harlem Hospital Center (HHC) since July of 2017 (1). We discuss the results and lessons learnt following its implementation. METHODS: MDT at HHC consists of pulmonologist, internist, respiratory therapist (RT), nurses, case manager ,social worker and pharmacist. All working in concert to implement a safer hospital discharge of COPD patients. RESULTS: COPD readmission rate for each quarter from July 2017 until September 2018 has been 14%,10%,38%, 21% and 17% respectively. Further sub-group analysis of COPD readmissions versus non-readmissions revealed that both groups had 100% compliance with pulmonary consults and smoking cessation counseling. Both groups had a less than 10% show rate at the clinics following discharge. Readmission arm had almost 90% more discharges against medical advice (AMA) compared to the non-readmission arm. CONCLUSIONS: There are valuable lessons learnt from implementation of MDT. Previously, we believed readmissions were due to inconsistent inpatient follow up by pulmonologists and low show rates in clinics following discharge. But after analyzing data acquired from MDT at HHC (shown in results), we have realized that highest readmissions are seen in high risk populations, those prone to AMA and multiple social issues. Identifying this high risk population and initiating appropriate interventions can be pivotal in reducing readmissions. Although, specialist care are valuable assets in their initial management but dedicated and adequate care manager/social work services are mandatory to this patient population. CLINICAL IMPLICATIONS: Thus, we at HHC are advocating towards allocating intensive social work resources to these patient population and also suggest that hospitals while adopting MDT, should consider an equally strong and adequately staffed care manager/social work services along with competent specialist services. Reference: 1. Kuzma AM, et al. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):567-71. DISCLOSURES: No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Margaret Olibrice Saint-Fleur, source=Web Response No relevant relationships by Mallika Pradhan, source=Web Response No relevant relationships by Griwan Rajbhandari, source=Web Response