REDUCING COPD READMISSION

Abstract

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Given ever increasing health care costs, measures to try to prevent repeated hospital readmission have taken to the forefront. There is increasing focus on appropriate discharge-planning bundle that would adequately decrease readmission for COPD exacerbation. Our study aimed to try to find a concise, easily executable, and effective discharge bundle to prevent recurrent readmission. METHODS: An interdisciplinary admission and discharge bundle order set was implemented in June of 2018. The order set brought in a COPD navigator who reviewed patient's medications inhaler technique, smoking cessation, vaccinations and scheduled outpatient follow up within a week. Education of patients on pulmonary rehabilitation as well as other community resources available for support was provided. Consecutive unique patients admitted with COPD exacerbation as a diagnosis (primary or secondary) from June 2017 to June 2019 were included. Baseline data for each patient including demographics, most recent pulmonary function tests, treatment and comorbidities was obtained and reviewed. Primary end point was 30 day readmission rate. Secondary outcomes included length of stay and mortality. RESULTS: Of 531 patients 331 patients were in the pre implementation group. Overall, the 30 day readmission rate for the entire study was 19% (100), ICU admission rate of 9% (46), inpatient mortality 1.13% (6) and 90 day mortality 4.36% (23). Baseline characteristics including inhaler usage, oxygen requirements and comorbid conditions were similar in both groups. The Charlson Comorbidity index was (5.1 vs 4.9 p=0.2) in pre and post groups. FEV1 was (25.7 vs 20.0 p=0.2) in pre and post intervention groups. Prior inhaler therapy, single (13% vs 11% p=0.9), double (21.8 vs 23% p=0.9) and triple (36.9% vs 38.5% p=0.9) were not significantly different in pre vs post groups. Admission WBC (10.5 vs 10.5 p=0,4) and PCo2 (51.5 vs 50.8 p=0.6) in pre and post intervention were also alike. ICU admission was 10.8% in pre group and 5.8% in post group. Bundle implementation was 39% in the post group and 0.3% in the pre group. The primary endpoint of 30 day readmission was (20.9% vs 15.7%.p=0.1) in pre and post intervention groups. The median length of stay was 3 days (0-40) vs 3 days (1-41) in the pre and post groups. The 90 day mortality was similar (5.1% vs 3.1%, p=0.3) in the pre and post groups. CONCLUSIONS: We encountered challenges in implementation. Lower utilization of the bundle accounted for the clear lack of effectiveness. Despite this underutilization, there was still a numerical reduction in readmission which didn’t meet statistical significance which could be due to low numbers. There is room for improvement in better implementation of recommendations from the COPD navigator. CLINICAL IMPLICATIONS: Better implementation of a COPD discharge bundle may decrease COPD readmissions. DISCLOSURES: No relevant relationships by Alejandro Arroliga, source=Web Response Stock ownership relationship with Pfizer Please note: $1-$1000 Added 06/02/2020 by Carl Boethel, source=Web Response, value=Stock ownership No relevant relationships by Shekhar Ghamande, source=Web Response No relevant relationships by Tasnim Lat, source=Web Response No relevant relationships by Meghan McGraw, source=Web Response No relevant relationships by Kristen Newman, source=Web Response No relevant relationships by Kiumars Zolfaghari, source=Web Response