Assessment of Provider Compliance Using an ED Protocol to Improve Care of COPD

Introduction: COPD is a chronic, irreversible disease that, when poorly controlled, is associated with high patient morbidity and mortality as well as a significant financial burden on the healthcare system. Although the management of this disease is multifactorial and complex, preliminary data from a comprehensive multi-disciplinary Emergency Department (ED) care plan specific to COPD patients has demonstrated improved patient outcomes and reduced hospital admissions. In the ED at Henry Ford Wyandotte Hospital (HFWH), a respiratory therapy bronchodilator protocol (RTBP) was designed and implemented. The RTBP was used to assess the patient’s current use of medication, state of their equipment, and enrollment in outpatient COPD programs. The RTBP was designed to give the ED provider additional information about the patient’s current state of their COPD disease. This would enable improved current ED and outpatient management of the patient’s COPD. The purpose of this quality improvement project was to ensure that the RTBP is being ordered by our ED physicians and residents on patients that presented with a respiratory complaint to the Emergency Department. These results will be used to assess the impact of the RTBP on COPD admissions/readmissions at our hospital in an ongoing study. Methods: A retrospective medical record cohort chart review was completed on all patients with an ED discharge diagnosis using specific ICD 10 codes related to COPD. These codes included: J96.00 (acute respiratory failure), J96.20 (acute and chronic respiratory failure), J44.1 (COPD with exacerbation), and so on. Patients were older than 18 years and presented to the HFWH Emergency Department between September 2017 to September 2018. They all received Duo-Neb (ipratropium-albuterol) nebulizer therapy during their stay in the ED. We then compared, by ordering provider, patients who had the RTBP protocol and Duo-Neb therapy ordered with those who did not have the RTBP protocol ordered. This data was used to calculate overall provider compliance in ordering the RTBP. We then designed an educational intervention to improve ordering compliance by ED providers.ResultsOverall compliance of providers ordering the RTBP and Duo-Neb, for the months of January and February of 2018, was 41.4%. After the educational intervention, compliance rate of providers ordering the RTBP and Duo-Neb in January and February of 2019 increased to 60%. This represents an increase in compliance of 18.6% which we attribute to our educational intervention. Preliminary results from the COPD admissions study have demonstrated a 40% reduction in admissions for COPD compared to the previous year. Conclusion: Specific educational interventions for ED providers regarding the ordering of pre-existing protocols can increase compliance in use of these protocols. We still did not reach 100% compliance. We will be doing additional studies/interventions to reach the 100% compliance goal. Increased compliance and use of the RTBP in the ED may lead to more reductions in admissions/readmissions in the COPD patient population.https://scholarlycommons.henryford.com/merf2019qi/1003/thumbnail.jp