Respiratory Care Practitioner; Continuum of Care for COPD Patient

Susan Pfanner, CRTOHVI Cardiovascular Wellness & Rehabilitation

Objectives for the New RCP Improve ability to communicate with

patient, other caregivers what outpatient pulmonary rehabilitation and Better Breathers Clubs are.

Increase understanding of pulmonary rehabilitation’s role in the discharge planning and coordinated care model.

Respiratory TherapistsBegin with first assess & evaluation From ER to Medical Floor to Home/SNF or Rehabilitation Where do patients go to regain strength and get back to living life?

Talking with your patient

Recovering from a hospitalization often means adjusting lifestyle.

When providing care, you have an opportunity to share a bit of yourself as their respiratory therapist.

Help them to understand what to anticipate.

Discharge Planning for the RCP Be a team player Be a good listener Be an assessor Make no assumptions Be ready to learn Document in chart/EMR Be an educator Pay attention to details Begin with end in sight

MCKENZIE-WILLAMETTE MEDICAL CENTER 88%

SACRED HEART MEDICAL CENTER – RIVERBEND 84%

Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home

MERCY MEDICAL CENTER 81%

SALEM HOSPITAL 85%

SAMARITAN ALBANY GENERAL HOSPITAL 83%

Medicare hospital compare (HCAHPS) Data collected 7/1/2010-6/30/2011; U.S. Department of Health & Human Services

This result is a ratio calculated by dividing the amount Medicare spends per patient for an episode of care initiated at this hospital by

the median (or middle) amount Medicare spent per patient nationally.

Spending per Hospital Patient with Medicare

MCKENZIE-WILLAMETTE MEDICAL CENTER 0.91

SACRED HEART MEDICAL CENTER-RiverBend 0.92

MERCY MEDICAL CENTER 0.87

SALEM HOSPITAL 0.91

SAMARITAN ALBANY GENERAL 0.85

Medicare hospital compare (HCAHPS) Data collected 7/1/2010-6/30/2011; U.S. Department of Health & Human Services

From Hospital…

Discharge planning begins on admission.

To home…

Transition home is health promotion.

Pulmonary Rehabilitation Treatment for Lung Disease

Improve respiratory muscle function Pulmonary Rehabilitation LVRS – surgical removal of portion of lung(s) Lung Transplant Trial – Endobronchial valve for Emphysema

http://www.emphasysmedical.com/animation%2Dpopup%2D08/

Functional Ability Impaired

Dyspnea Deconditioned Recurrent/Chronic Lung Infection Activities of Daily Living/ Quality of Life Compromised

Appropriate Diagnoses

Obstructive Lung Disease with FEV1/FVC ≤ 69% of Predicted

Appropriate Diagnoses

Restrictive Lung Diseases (FEV1 or FVC ≤ 59% or

DLCO ≤ 59% of Predicted)

Pulmonary Rehabilitation

Physician referral, PFT, Insurance Auth. 12-24 Visits over 90 days Initial Assessment, Pre-6 minute walk Breathing training, Monitored exercise, O2 provided to keep SpO2 ≥ 92% (Rx) Exercise and Education at each session Support for the caregiver/spouse/family

PeaceHealth Pulmonary Rehabilitation

Springfield, ORSHMC RiverBend, OHVI

Cardiovascular Wellness & RehabilitationFlorence, OR

PeaceHarbor HospitalCardiac & Pulmonary Rehabilitation

Longview, WASt. John Medical Center

Cardiac & Pulmonary RehabilitationVancouver, WA

Southwest Medical CenterHeart & Vascular Center

Maikey Lopera, Exercise Physiologist with Patient in east gym at OHVI

Supervised Exercise Program following Pulmonary Rehabilitation

Upon discharge & post 6 minute walk Patients are encouraged to continue Setting is familiar and spouse/family

member is allowed to join Gym available 5 days a week Tai Chi (2-5 sessions/ week) Chair Yoga (3 sessions/ week)

Ongoing exercise conditioning includes more than treadmill walking

Left: Nu-Step, Seated recumbent stepper; Above: Suman Barkhas outside at World Tai Chi

Day

BETTER BREATHERS CLUB Meet monthly to provide an outpatient support for people affected by lung disease.

Second Wednesday at SHMC-RiverBend-OHVI

Third Tuesday at MWMC

Willamalane Senior Center Annual pulmonary rehabilitation reunion and BB picnic held 2009 Island Park, Springfield

Thank you for the work you have done and are going to do!

Make a difference in a patient’s life - allow them to share their story with you.

Help the next chronic lung disease patient you work with understand how to take better care of their breathing.

Transform the knowledge of respiratory care modalities delivered in hospital to ways of delivering care outside that typical setting.

In Summary

Role of RCP may be underestimated As an RCP, you are an educator Align yourself with physicians, nurses,

other therapies to be a team player Success in discharge planning may be

directly linked to relationship you develop with team members

Thank You Norma & Kellee!

Respiratory Care Program at LCC wouldn’t be the same without you!