Highland Hospital created a weekly COPD clinic to provide follow up care for discharged patients.
Our readmission rates for COPD were very high, partially because COPD is such a sensitive condition and partly because patients weren’t able to schedule timely follow up appointments. We reached out to our emergency room respiratory therapists to understand the direct causes of readmissions, and realized many were coming back for preventable reasons. The main one was that inhalers are hard to use correctly, causing patients to overuse them. Inhalers have a limited number of squirts and you’re only eligible for a refill every 30 days, so patients were using up their inhalers without being able to get new ones. There are also a lot of triggers for COPD exacerbations that patients weren’t aware of, like smoking and getting sick.
Highland Hospital is a non-profit teaching hospital in Oakland, CA. It is a safety net setting hospital with 236 beds that serves a diverse population including low-income, uninsured, and vulnerable populations. Their transitions program began in 2012 and is influenced by Project RED and the Transitional Care Model.
What We Tried
We started offering a COPD clinic one morning a week at one of our outpatient clinics. It is staffed by our care transitions nurse and pharmacist, a respiratory therapist, and a doctor. We recommend that anyone discharged from the hospital with COPD go to the clinic at least once for their first follow up appointment, but they are welcome to come back as many times as they need to. The clinic is open to anyone who has been discharged from the hospital with COPD. We offer education on how and when to use inhalers and nebulizers, thorough medication reconciliation, breathing exercises, flu and pneumonia shots, and smoking cessation support. When patients run out of medication prematurely, our pharmacist can prescribe more.
The clinic has really reduced our readmission rates. Of the COPD patients discharged from the hospital, those who go to the clinic are 30% less likely to be readmitted. The challenge now is to get more people to go to the clinic because right now only about half of our patients come.
The clinic has also been so successful that we’re taking in patients directly from local clinics and the emergency department now. In this sense, we’re not only reducing readmissions, but also admissions in the first place.
While running the clinic is a lot of work, it surprisingly hasn’t overextended us. Clinic visits can essentially replace home visits, so even though we’re devoting one morning a week to the clinic, it’s like conducting 5-10 home visits in that time frame.
Our patients have really found the peer support at the clinic valuable. It’s not easy to have these conditions and sometimes it helps to just talk to someone else going through the same things. Sometimes what other peers say can be more credible than what health care professionals tell you.
The respiratory therapist on our team has been a great resource and is a much better teacher than we could ever be.
Having no wait times is important—otherwise patients will just leave. Since peer support is so valuable, we encourage patients to talk with each other in any down time they have.
We’ve found it helps to have a way to create a private room, if needed—especially for patients with depression or anxiety.