A Quality Improvement Plan to Ensure Receipt of Prescribed Home Respiratory Equipment

Background: In our pediatric institution, a dedicated respiratory therapist (RT) discharge planner coordinates the inpatient acquisition of home respiratory equipment, while multiple RTs assist with outpatient orders. Lengthy delays in receiving equipment have occurred, including cases with significant delays not discovered until hospital readmission. With no process in place to ensure that ordered equipment was provided, delays and associated obstacles were unknown or inconsistently reported. Methods: We conducted a quality improvement study in which a follow-up process was implemented to confirm delivery of home equipment ordered through inpatient discharges and the outpatient pulmonary clinic. The process consisted of the RT who assisted with the order placing a follow-up call to the caregivers, intervening when necessary, confirming receipt of equipment. To evaluate the process, a retrospective and prospective chart review was done from November 2017-April 2019. The length of time to obtain equipment and reasons for delay were monitored before and after process implementation. Orders for oxygen, pulse oximeter, suction, airway clearance devices, CPAP, and bi-level devices were included. Home ventilators were excluded because they must be utilized prior to discharge. Results: Records were reviewed for 257 orders for home respiratory equipment. Of 182 inpatient orders (92 pre/90 post), there was no change in the mean number of days to obtain the equipment after process implementation. Delays were due to late notification to the discharge planner, orders placed after discharge or on a holiday, and difficulty contacting caregivers for delivery. For the 75 orders originating in the pulmonary clinic (35 pre/40 post), the mean number of days to obtain equipment decreased from 24 days to 12 days post implementation. Outpatient delays were due to the equipment provider not receiving faxed orders, difficulty in obtaining a provider of pediatric-specific equipment, insurance verification, and the need for additional documentation of medical justification. See table. Conclusions: As equipment ordered during an inpatient hospitalization is generally delivered prior to discharge, the follow-up process had minimal effect on equipment delays. By providing early problem identification and timely intervention, the outpatient RTs role is valuable in reducing delays in equipment acquisition.