The purpose of this project was to improve patient clinical outcomes of average length of stay, mortality rate, and readmission within 30 days by increasing health care provider order set usage and documentation as it relates to patients with a primary diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Epic ™ computer based clinical documentation by healthcare providers at The Christ Hospital (TCH) was inconsistent. The PICOT question developed was: in the COPD population of an acute care hospital, how does standardized electronic COPD process measure documentation and order set usage compared to no COPD process measure documentation and order set usage effect patient outcome measures, within a two month timeframe? The Evidence Based Practice Improvement Model was used to guide the project. The evidence base for the documentation improvement in the project was the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Two opportunities to improve the documentation were the COPD exacerbation order sets and a Respiratory Therapy (RT) COPD assessment. The COPD Exacerbation order set for health care providers included a general information section, consults, nursing orders, respiratory orders, and medications. Specific orders were pre-checked, giving the healthcare provider an opportunity to check or uncheck any individual order in each section depending on the individual patient. The RT COPD assessment consists of six categories for documentation: 1) baseline activity, 2) COPD Assessment Test (CAT™), 3) Spirometry Classification, 4) COPD exacerbations, and 5) COPD diagnostics, and 6) COPD Inhaled Therapy Score. Tests of change included creating, implementing, re-vising, and reeducating the COPD exacerbation order set usage and the RT COPD assessment standard documentation flow sheet in Epic ™ production. Both documentation improvement opportunities were placed into Epic ™ Production.
A total of 151 acute care admissions (ACA) were reviewed from November 1, 2014 through January 31, 2015. The COPD exacerbation order set usage and documentation compliance reached the desired outcome of 50% week five. The best single week for COPD exacerbation order set usage at 66.7% week thirteen. The RT COPD assessment documentation exceeded the desired outcome of 100% week fourteen. The clinical outcomes data varied from November 2013 to January 2014. The ALOS varied from 5.91 days in November decreasing to 4.56 days in December and 5.84 days in January. Mortality rate varied from 3.03 in November decreasing to 0.00 in December and 1.35 in January. The percent of COPD patients readmitted within 30 days was 18.75 in November decreasing to 11.54 in December, and 15.07 in January. All three clinical outcome measures for the same comparable quarter timeframe: ALOS, mortality rate, and readmission with 30 days decreased. ALOS decreased from 5.08 for Oct – Dec 2013 to 4.98 for Oct – Dec 2014 (a decrease of 0.1). Mortality rate decreased from 1.77 for Oct – Dec 2013 to 1.63 Oct – Dec 2014 (a 0.14 decrease). Readmission within 30 days decreased from 14.41 for Oct – Dec 2013 to 14.05 for Oct – Dec 2014 (a 0.14 decrease).
Biery, K. (2014). Improvement of Standardized Documentation of Patients with COPD in an Acute Care Setting. . Wright State University, Dayton, OH.