Standardization Seeks to Improve Quality of Care for Patients with Pulmonary Disease

Innovations in Pulmonology & Sleep Medicine | Winter 2022

The lack of standardization of care in patients with pulmonary diseases — in particular chronic obstructive pulmonary disease (COPD) and pneumonia — can lead to longer hospital stays, which may increase the risk of hospital-acquired infections and complications and impair patients’ quality of life. Providing consistent care to this population is challenging.

Jihane Faress, MD

In addition to her clinical work, Jihane Faress, MD, Director, Interstitial Lung Disease Program, University Hospitals Cleveland Medical Center, is focused on improving quality at the patient and system level for this patient population.

“When we talk about quality care, we’re talking about care that is effective, efficient, equitable, safe, timely and patient-centered,” Dr. Faress says. “Quality gaps in the care of patients with COPD and pneumonia are certainly not unique to University Hospitals. However, we do want to be more patient-centered in our overall approach to medicine and, specifically in this population, taking into account patients’ values and preferences.”

Standardizing care

Clinicians can take several simple but important steps to improve quality care to this patient population, beginning with standardizing care.

“We started to standardize the care we deliver, rather than defaulting to an a la carte approach depending on who’s actually providing the care,” Dr. Faress says. “To help us do this, we collaborated with the infection control committee and conducted a thorough literature review. This allowed us to revamp our order sets for COPD and pneumonia using evidence-based guidelines.”

Just having electronic medical records was not enough to encourage clinicians to use the revised order sets, which can sometimes be seen as cumbersome, so Dr. Faress launched an education campaign targeted at all levels of the organization.

“We disseminated the value of using order sets by engaging and educating our colleagues,” she says. “We anticipated that wide adoption might decrease hospital length of stay, reduce unnecessary admissions and possibly reduce mortality. After three months, we are already seeing improvements.”

Reducing hospital readmissions

Influencing modifiable patient factors can also reduce hospital readmissions.

“It’s important that patients understand their at-home care before they leave the hospital, so we use the widely advocated teach-back method,” Dr. Faress says.

The teach-back method increases the likelihood that patients will clearly understand important health information by asking them to repeat back — in their own words — what they heard from their provider. According to the Agency for Healthcare Research and Quality¹, patients forget 40 to 80 percent of the medical information their doctor tells them, and nearly half the information they do retain is incorrect.

“We make sure patients really understand what we tell them before they go home, and we involve their family and caregivers, as well,” Dr. Faress says. “For example, a nurse or respiratory therapist will teach COPD patients how to properly use their inhaler. We’ll also send them home with a supply of medication and schedule a follow-up appointment with their provider seven to 10 days after leaving the hospital. This reduces the risk the patient will have to visit the emergency room or be readmitted.”

Early results show improvement

Although there’s more to do, standardizing the approach to patient care is generating positive results at University Hospitals Cleveland Medical Center, and it has already seen more than doubling in the usage of the pneumonia order set, Dr. Faress says.

“Our success is based on finding what is not working, capitalizing on the available resources we have, and working as a team,” she says. “We’ve engaged staff at every level at University Hospitals Cleveland Medical Center, including the Department of Medicine leadership and our house staff. These measures are having several positive implications, including enhancing patient centeredness, improving patient safety, eliminating redundancy and positively impacting physician satisfaction.  In addition to improving patients’ wellness at home, reducing avoidable readmissions also increases University Hospitals’ capacity to care for other patients.”

Dr. Faress says she’s excited about this project and looks forward to continuing to make a positive impact on pneumonia and COPD.

For more information about these quality initiatives, call Dr. Faress at 216-844-8500.

1. Health Literacy Universal Precautions Toolkit, 2nd Edition. Agency for Healthcare Research and Quality.

Contributing Expert:
Jihane Faress, MD,
Director, Pulmonary Section Quality Improvement and
Director, Interstitial Lung Disease Program 
Division of Pulmonary, Critical Care & Sleep Medicine
University Hospitals Cleveland Medical Center
Assistant Professor of Medicine
Case Western Reserve University School of Medicine