COPD insider

3 strategies to optimize discharge planning and reduce COPD readmissions

 

COPD patients are most vulnerable in the days following hospital discharge. Read on to see how improving discharge planning can reduce costly COPD readmissions.

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It’s well established that patients with COPD are most vulnerable to adverse events in the days following discharge. As this can lead to more issues and exacerbations, it can undermine your efforts to reduce COPD readmissions1 and readmission penalties2. Clearly, better discharge planning is an imperative for care teams everywhere.
About two-thirds of patients hospitalized following a COPD exacerbation are released to a home environment.”

The COPD Foundation

As a preliminary step, researchers have systematically reviewed published studies on effective discharge. These reviews illuminate gaps in care during transitions — and significant opportunities for improving discharge protocols.3

Contributor

Krystal Craddock

Krystal Craddock
BSRC, RRT-NPS, AEC

COPD Case Manager

Department of Respiratory Care at UC Davis Medical Center

1

Shift your thinking4

As health systems shift from volume- to value-based care, it’s important to shift your thinking from COPD as a single event to a chronic disease that impacts a broad continuum of care. A good start is to focus on the patient. For example, the Centers for Medicare & Medicaid Services (CMS) proposes more patient-centered practices that enable you to personalize your discharge plan and enable successful treatment across settings.

Key considerations for enhancing your discharge plans

 

Make it reflective of each patient’s

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Goals
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Strengths
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Preferences
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Post-discharge needs
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Risk for COPD readmission

Make it inclusive of
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Respiratory Care Departments in coordinating post-acute care
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Respiratory therapists’ expertise and evaluation of the patient
The first step to a truly effective discharge plan is to shift your thinking. Discharge is not an isolated event, but part of the entire continuum of care for the patient.”

Krystal Craddock, BSRC, RRT-NPS, AEC

COPD Case Manager, Department of Respiratory Care at UC Davis Medical Center

2

Maximize your respiratory therapists5

In an interview with the American Association of Respiratory Care, Krystal Craddock, BSRC, RRT-NPS, AEC, COPD Case Manager at the Department of Respiratory Care at UC Davis Medical Center describes Respiratory Therapists as the bedside clinical experts on pulmonary diseases, including COPD.

 

As the experts in COPD care, RTs are uniquely qualified to facilitate transitions in careand play an invaluable role in discharge planning.

 

 

No other licensed clinician has more knowledge of COPD pathophysiology, medications, equipment, diagnostics, and treatments for than an RT.”

Krystal Craddock, BSRC, RRT-NPS, AEC

COPD Case Manager, Department of Respiratory Care at UC Davis Medical Center

Build your discharge plan around RTs

 

RTs are invaluable for providing

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Education to patients on management of their disease
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Nonjudgmental and empathic advocacy
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Up-to-date knowledge of current:

  • Treatments
  • Medical equipment
  • Insurance coverage
  • Resources available to patients
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Individualized care according to patient needs
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The ability to adjust to an evolving healthcare environment
Empowering these specialists does not just help support better health, it can directly enhance the impact of an existing COPD readmission reduction program.
3

Focus on the human side of readmissions

According to the COPD Foundation, COPD-related exacerbations cause about 700,000 hospitalizations and 1.5 million emergency department visits per year. Another 3.8 million hospital stays include COPD as a secondary or complicating condition.5

 

While these add up to an astronomincal financial cost, there is a human cost as well. As we continue to learn about the psychosocial aspects of patients living with COPD, studies can help us better understand what patients need as they transition from one care setting to the other.

 

In one study, COPD patients shared their experiences while participating in their own care at discharge and in the following days at home. The study showed6

Hospital

Patients in the hospital phase:

 

  • Struggle to regain a sense of control
  • Need to build strength and readiness for discharge
  • Seek clarity and confidence
Home

Patients in the home phase:

 

  • Need encouragement to maintain wellbeing
  • Have trouble staying motivated and confident
  • Strive to comply with professional advice
This study reinforces that patients struggle to transition between different settings on their own. They thrive on support, direction, and motivation. Be sure to build these into your plan, as you extend your consideration to patient engagement.

COPD readmission rates are only part of the equation7

Repeated exacerbations can take a toll on patients and lead to:

 

  • Reduced quality of life
  • Increased inflammation
  • Faster disease progression
  • Increased risk of recurrent exacerbations
  • Longer hospital stays
  • Increased risk of mortality
Including patients in their care increases adherence because you are tapping into what’s meaningful and attainable in the real-world management of their disease.”  

Krystal Craddock, BSRC, RRT-NPS, AEC

COPD Case Manager, Department of Respiratory Care at UC Davis Medical Center

Case study: Dramatic drops in readmissions and mortality

Outcome

The need

Craddock learned that her organization’s discharge planning process was historically siloed by department. This created inefficiencies as patients were leaving the hospital, which increased risk of COPD readmissions.
Outcome

The solution

She shifted thinking of COPD management from single events to a longitudinal process. Craddock trained her team to become COPD Case Managers by studying motivational interviewing, health literacy, and thinking beyond acute care.
Need

The outcome

Drastic drop of COPD readmission rates to 7%—well below the national average—helped them account for quality and patien-centric protocols, especially as patients transitioned from the inpatient to outpatient setting.
In addition to low readmission rates, we also have one of the lowest mortality rates—lower than 96% of hospitals in the US. We must be doing something right.”  

Krystal Craddock, BSRC, RRT-NPS, AEC

COPD Case Manager, Department of Respiratory Care at UC Davis Medical Center

Make the shift from hospital to home a success

With such a complex disease with a multitude of care settings, discharge planning is no easy task. However, by implementing these 3 strategies into your discharge process, you can transform more COPD readmissions into success stories of keeping patients healthy at home.
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Further reading

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  • 4 keys to sustainable readmission reduction

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References

1. Mahler D. Risks After Hospital Discharge for COPD flare-up. http://www.donaldmahler.com/risks-after-hospital-discharge-for-copd-flare-up/. Accessed August 30, 2018.

2. CMS.gov Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program.html#main_content. Accessed August 30, 2018.

3. Blaha, Daniel, MSN; Vandenhouten, Christine, PhD, APHN-BC; Ramirez, Jolene, MS, MSN, RNC-OB, NE-C; Pomasl, Julie, MSN; Skarda, Hope, BSN, RN. Nursing Management.https://journals.lww.com/nursingmanagement/Fulltext/2018/01000/Post_hospitalization_management_of_patients_with.6.aspx. Accessed on August 30, 2018.

4. American Association of Respiratory Care. Advocacy/Federal Policies and the RT. http://www.aarc.org/advocacy/federal-policies-affecting-rts/discharge-planning/. Accessed August 30, 2018.

5. Association of Respiratory Care. COPD Case Management by RTs: Where We Are, and Where We Would Like to Be. http://www.aarc.org/careers/career-advice/professional-development/copd-case-management-rts-like/American. Accessed August 30, 2018.
6. Ingrid Charlotte Andersen, Thora Grothe Thomsen, Poul Bruun, Uffe Bødtger & Lise Hounsgaard (2017) The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study, International Journal of Qualitative Studies on Health and Well-being, 12:1,

7. https://www.tandfonline.com/doi/full/10.1080/17482631.2017.1371994. Accessed August 29, 2018.

8. Willard KS, Sullivan JB, Thomashow BM, et al. The 2nd National COPD Readmissions Summit and beyond: from theory to implementation. Chronic Obstr Pulm Dis. 2016; 3(4): 778-790. https://journal.copdfoundation.org/jcopdf/id/1128/The-2nd-National-COPD-Readmissions-Summit-and-Beyond-From-Theory-to-Implementation. Accessed on August 29, 2018.

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