PURPOSE: Harlem Hospital Center is a community hospital in Northern Manhattan with one of the highest asthma related ER visits in New York City. Patient education, medication adherence and inhaler technique have been shown to be extremely valuable adjuncts in preventing Asthma and COPD exacerbations. We present a quality improvement project highlighting the importance of inhaler technique in reducing ER visits and hospitalizations in patients visiting the Chest Clinic at Harlem Hospital Center. METHODS: We randomly selected 25 patients with a diagnosis of either COPD or Asthma. These patients were prospectively followed from February 2015-October 2015. During each visit they were educated, with focus on inhaler technique by a patient educator. We then compared ER visits and hospitalizations before and after the intervention. Outcome measures included the number of ER visits and hospitalizations post intervention. Positive outcome was defined as a reduction in ER visits/ hospitalizations and no outcome represented no reduction in ER visits/hospitalizations. RESULTS: The inhaler technique intervention had an overall positive outcome in 84% of the subjects (n=21) and no outcome in 16% (n=4). Out of the 21 patients with a positive outcome, 13 patients carried a diagnosis of asthma. They had 82 ER visits in total prior to inhaler technique education, and 7 after, corresponding to a 91% reduction. 8 patients with COPD accounted for a total of 18 hospitalizations prior to inhaler technique education, and 3 after, corresponding to an 83% reduction. Amongst these 8 patients, there were 34 ER visits prior to inhaler technique education, 7 after, corresponding to a 79% reduction. CONCLUSIONS: We report a drastic reduction in the number of ER visits/hospitalizations in patients who received the inhaler technique education at the Chest Clinic of Harlem Hospital Center. A major limitation of these results is the lack of accountability for confounders such as vaccinations, medication adjustment or smoking cessation. Nonetheless, we submit this project to serve as a pilot study to continue to focus on preventative and cost-effective measures that are an integral part of care for patients with COPD and asthma.
Riar, R., Carrasco, L., Olibrice, M., & Ayinla, R. (2016). Patient Education With Inhaler Technique to Prevent Readmissions and Emergency Room (ER) Visits in Asthma and COPD: A Quality Improvement Project at an Inner-City Hospital. Chest, 150(4), 632A. https://doi.org/10.1016/j.chest.2016.08.724