Improving Pulmonary Rehabilitation Referral Rates in Inpatient Discharges

Abstract

A quality improvement project was implemented at our institution for improving referral rates for pulmonary rehabilitation (PR) for COPD patients in the inpatient setting. METHODS: Data for 158 PR referrals in hospitalized pulmonary disease patients from January 2019 to February 2020 were obtained. This data set included information such as referring providers, patient diagnosis, and patient participation in PR. We proposed and implemented our intervention in October 2019 and compared the number of referrals and specialty of referring providers pre-and post-intervention. Our intervention consisted of the addition of a PR order in the discharge order set for all chronic lung disease patients that qualify. In addition, as well as a notification via email to all hospital providers. RESULTS: A retrospective analysis of a total of 158 PR referrals for patients with chronic lung diseases examined before and after the intervention was implemented. The intervention consisted of the addition of a PR order in the discharge order set and implementing education for providers. Before the intervention, an average of nine patients per month were referred to pulmonary rehab over the retrospective chart review from the months of January 2019 to September 2019. After the intervention, the average of patients being referred to pulmonary rehab increased to fourteen patients per month. The result of the improvement increased by 64%. A limitation to the study is population size and non-random seasonal variation, we intend to collect further data in order to solidify our conclusion. CONCLUSIONS: Pulmonary rehabilitation is considered one of the most vital management options in patients with chronic lung disease based throughout multiple organizations such as Global Initiative for Chronic Obstructive Disease. With improvement of exercise capacity, lung function to decreasing total hospital stay and recurrent hospitalization rates, studies have shown decreased frailty in patients and improved quality of life. Our goal for conducting this intervention of our quality improvement project was first initiated by recognizing the benefits of pulmonary rehabilitation. Next, we were able to identify the problem of minimal referrals being sent and developed a solution to improve overall outcomes. We then were able to collect the data and upon the analysis, we implemented a successful outcome with an improvement of over 60%. CLINICAL IMPLICATIONS: Guidelines from American College of Chest Physicians and the American Association of Cardiovascular have grade 1A recommendations for pulmonary rehabilitation (PR) in chronic obstructive lung disease (COPD). PR has been proven to improve fatigue, dyspnea, exercise capacity, and overall emotional well-being in patients with chronic lung disease. Furthermore, it has been shown to decrease hospital readmissions by 42% at 12 months for COPD exacerbations.