Improving Follow Up After Inpatient Initiation of Noninvasive Ventilation

Abstract

Background:

Timely outpatient follow-up after initiating noninvasive ventilation (NIV) during an inpatient stay is essential to ensure the effectiveness, efficacy, and safety of the prescribed intervention. Connecting with outpatient providers soon after discharge provides access to care allowing proper troubleshooting, potentially decreasing morbidity and re-hospitalization. We aimed to improve timely follow-up of patients discharged from the hospital after initiation of NIV in our outpatient sleep or pulmonary clinics as defined by increasing the percentage of newly initiated NIV patients discharged from inpatient and scheduled for follow-up in the outpatient sleep/pulmonary clinic within 30 days from 33% to 50% by December 2020.

Methods:

A driver diagram was created to identify barriers to timely outpatient follow-up. A shared EPIC list was created to identify new NIV patients slated for discharge. Patients on this list were identified for teaching by nursing and respiratory therapy and for tracking by our sleep center coordinator. Several new tools were created to assist with communication and workflow: A hand-off smart phrase for EPIC notes to facilitate the transition to outpatient care, including a summary of patient settings, new sleep consult order to facilitate follow-up scheduling. Workflow was developed and disseminated to pulmonary service/consult teams, durable medical equipment companies, inpatient nursing, case management, respiratory teams, outpatient nurses, respiratory therapists, and sleep coordinator. With IRB approval, data were collected from 8/2020 to 01/2022.

Results:

192 patients were initiated on NIV and discharged in the 18-month surveillance period. 89% had a specialty outpatient appointment following discharge; 56% were seen within 30 days, 81% were seen within 60 days. Mean ± SD time to follow up appointment was 29.8 ± 25.5 days. Of those that did not follow up, 10 (5%) followed up locally, one followed up with an adult provider, 6 passed away (3%), and 5 (3%) were unaccounted for. The percentage of patients readmitted for any reason was 11% with 3% for respiratory reasons. A Healthy Planet reporting tool was launched to automate tracking of patients’ long term.

Conclusions:

A new standardized process to improve follow-up and interdisciplinary communication across the continuum was created to improve safety, effectiveness, efficiency, and outcomes reducing time to necessary care, reducing rehospitalization and disparities in care.