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Respiratory Care |

Multidisciplinary Intervention to Improve Readmission Rates of Patients Discharged With a Diagnosis of Pneumonia

Hussein Hussein; Marjorie Golden; Samuel Hahn
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Yale New Haven Hospital, St Raphael Campus, New Haven, CT


Chest. 2014;146(4_MeetingAbstracts):905A. doi:10.1378/chest.1989797
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Abstract

SESSION TITLE: Non-Ventilatory Respiratory Support

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: Pneumonia is the second most common discharge diagnosis among Medicare beneficiaries.Nearly 20% of these patients are readmitted within 30 days of discharge with cost exceeding $17 billion.In an attempt to improve the diagnosis and management of patients with respiratory infections,as well as improve rates of readmission,we made several interventions including multidisciplinary daily rounds for patients diagnosed with pneumonia and implementation of a diagnostic scoring system.

METHODS: A modified Clinical Pulmonary Infection Score MCPIS was implemented in 2012 at our institution as a quality improvement tool.This score includes temperature,WBC count,sputum cultures,oxygen requirements and radiographic appearance.Patients were classified into 3 categories of pneumonia diagnosis based on MCPIS: ≤ 3 unlikely,4-5 probable, ≥6 likely). Physicians from different medical divisions met daily with representatives of nursing,social work and continuing care to review patients admitted with pneumonia.The primary focus of these rounds was to ensure accurate diagnosis and ensure timely follow up after discharge.If the diagnosis was felt to be incorrect, the case was discussed with the team caring for the patient.We reviewed all patients discharged with a diagnosis of pneumonia between Nov-Jan 2011-2012 and Nov-Jan 2012-2013 before and after the intervention.

RESULTS: During the study periods,236 and 227 patients were discharged with a diagnosis of pneumonia.The all-cause readmission rates were lower after the intervention (13.2% vs. 20.7%, p=0.02).Similar findings were seen for patients readmitted with a diagnosis of pneumonia (3% vs. 10.5%, p=0.002). After implementation of MCPIS, accuracy of pneumonia diagnoses improved.Among patients with a discharge diagnosis of pneumonia, there was a significant increase in the mean MCPIS scores (4 to 6) before and after the implementation.The number of patients considered unlikely to have pneumonia fell from with 42.6% to 3.6%, those with probable pneumonia fell from 31.9% to 17.9% and patients deemed likely to have pneumonia increased from 25.5% to 78.6% These changes were statistically significant (p<0.0001).

CONCLUSIONS: A multidisciplinary intervention resulted in a significant decrease in readmission rates of patients discharged with a diagnosis of pneumonia as well as a significant improvement in the accuracy of discharge diagnoses.

CLINICAL IMPLICATIONS: Our intervention is an example of patient centered care with aim to improve the quality of care and reduce its cost.

DISCLOSURE: The following authors have nothing to disclose: Hussein Hussein, Marjorie Golden, Samuel Hahn

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