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1005 Reducing ed revisits among copd patients managed in ed observation unit: reliable implementation of copd care-bundle using improvement science
  1. Muhammad Zafar1,
  2. Timothy Loftus1,
  3. Jack Palmer1,
  4. Michael Phillips1,
  5. Jonathan Ko1,
  6. Steven Ward1,
  7. Eric Mueller1,
  8. Amber Dalhover1,
  9. Evaline Alessandrini2
  1. 1University of Cincinnati, US
  2. 2Cincinnati Children’s Hospital Medical Centre, US


Background COPD exacerbations (eCOPD) deleteriously effects patient outcomes and healthcare spending. Emergency Department observation units (ED-Obs) provide short-term acute care in order to reduce resource utilisation, however successful COPD-specific programs in ED-Obs are lacking.

Objectives Achieve 90% reliable implementation of COPD care-bundle among eCOPD patients discharged from ED-Obs by April 2017. The overall goal is to reduce 30 day all-cause ED revisits for eCOPD patients discharged from ED-Obs from the baseline rate of 49%.

Methods Setting: An 800-bed academic hospital with 700 eCOPD ED encounters/year, out of which 20% triage to ED-Obs. All patients triaged to ED-Obs with eCOPD diagnosis were included. A five-element COPD bundle designed to mitigate system-level failures, was adopted from in-patient setting. The bundle components were: appropriate inhaler regimen, 30 day inhaler supply, personalised inhaler education, standardised discharge instructions and follow-up in 15 days. A multidisciplinary team was formed to support bundle implementation within the 24 hours ED-Obs stay using Model for Improvement. Bundle component adherence and 30 day ED revisit rates were monitored using SPC p-charts. Hospitalisation rate from ED-Obs was used as balancing measure.

Results The patient characteristics were similar in baseline and post-bundle period. Multiple PDSA cycles were performed to achieve a final process (Figure 1). The adherence to COPD care bundle components has maintained >90% from 4/2017–8/2017 (Figure 2). The 30 day all-cause ED revisit rate reduced from 49% to 28% with a pending system-shift on SPC (Figure 3). Hospitalisation rate remained unchanged.

Abstract 1005 Figure 1

COPD care bundle delivery process in ED observation unit. COPD: chronic obstructive pulmonary disease, ED: emergency department, Obs: observation, d/c; discharge, dispo: disposition, Rx: prescription, HER: electronic health record, INH: inhalers, PCP: primary care provider

Abstract 1005 Figure 2

Process measure: adherence to COPD care bundle components. RT: respiratory therapists, MLP: mid-level provider, EMR: electronic health record

Abstract 1005 Figure 3

Outcome measure: 30 day all-cause ED revisit rate. COPD: chronic obstructive pulmonary disease

Conclusions Improving care at discharge transition of eCOPD patients from ED-Obs to home through reliable adherence to COPD care-bundle reduces 30 day all-cause ED revisits.

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