/ Print /

  • linkedin
  • Increase Font
  • Sharebar

    COPD executive care team cuts readmission rate in half


    MHE: What are two examples of recent initiatives?

    Anderson: One initiative that impacts both inpatient mortality and readmissions is advance care planning. This interdisciplinary team is led by the nurse director of spiritual care.  Our goal is to significantly increase the percentage of patients who have advance directives in their EHR, as well as referrals to palliative and hospice care. Having a plan in place reduces stress and anxiety for both the patient and their family. It also improves satisfaction with the dying experience.

    Beginning in 2021, there will be government penalties for excess mortality for COPD patients. We are currently developing a best practice alert for our EHR, which will pop up when the patient meets certain criteria for advance care planning. Because we are targeting COPD patients, we will start this work in pulmonary clinic and refine for use in primary care.

    A second initiative targets patients who have a history of tobacco use. There is evidence that low-dose computed tomography (LDCT) screening for patients who have a 30-pack year history helps to catch lung cancer at an early stage, when it is more treatable. A small group of respiratory therapists is working with our cancer center and pulmonary department to increase the number of referrals for LDCT screening. We identify qualifying patients seen in pulmonary clinic each week and inform the providers so they can make the decision on referral.

    MHE: What are some of the challenges of the executive care team?

    Anderson: Sanford Medical Center Fargo has three campuses. Especially in today’s climate of continual change, it is difficult pulling people together to meet, review outcomes, and plan for improvement.

    Current technology is valuable in overcoming this barrier. Besides conducting Skype meetings, our work pushes forward using smaller interdisciplinary executive groups to develop a project charter. We then pull in content experts from across the organization to form subgroups, working on specific goals within the charter, which can be completed in a relatively short period of time. The executive group is responsible for ongoing oversight. They also connect wherever needed within the organization, reporting out to such groups as administration, enterprise, quality, and physicians.



    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Follow Us On Twitter

    Find us on Facebook

    Latest Tweets Follow