Creating a Mobile Spirometry Unit
Grand Canyon University: HLT-313V-RS-T1
Proposed Initiative: Creating a Mobile Spirometry Unit
I will be talking about my proposed initiative of a Mobile Spirometry for respiratory patients who need to preform pulmonary function tests as part of their vital sets. I will be discussing why this will help with eliminating a risk of cross contamination between patients who are immunocompromised. Also will be discussing the effects of changing the system to a mobile spirometry unit and how it improves patient satisfaction (Press Ganey) by decreasing the wait time in between exams. Efforts to improve the value of health care in the United States of America have gained attention in the last recent years. As a part of the process there has been increasing emphasis on de-fining and measuring health care quality and by that Press Ganey was founded and pushed (tyser, 2016). It is pushed as far as reimbursement rates; the data is even being publically published so patients can make their own choice of where they receive care.
Initiative of Mobile Spirometry
Spirometry is a common office test; this is used to see how well your lungs work. It measures how much air is inhaled, and how much and how quickly it is exhaled. Having a mobile spirometry available for patients who are immunocompromised will help cut the risk of cross contamination between patients in the pulmonary function room. Another big factor will be a decreasing wait time for patients for when they have their spirometry being completed.
The cart will have the following items pulmonary function software on a laptop with spirometry equipment, mouth pieces, nose clips and cleaning supplies. This will allow for decreased risk for spreading of bacteria and decrease on clinical errors of data inputting. An improvised mobile spirometry unit would contain the pneumotach, mouth piece (a mouth filter) and a nose clip. The pneumotach would directly attach to the computer and work with the electronic medical record (EMR), decreased time by not having to wrap the pneumotach in plastic because it can be cleaned with the sanicloth (a powerful cleaning wipe that kills Pseudomonas Aeruginosa, Burkholderia Cepacia which is a nasty bug and detrimental to Cystic Fibrosis Patients.
Pulmonary function tests, called PFTs, are tests that see how well your lungs work. They are the most often ordered pulmonary lab tests. The spirometry is part of a pulmonary function test which was invented in 1840 by a surgeon, Dr. Hutchinson (wilde, 2007). The clinical indications for spirometry are varied and depend on the clinical settings and questions to be addressed. Generally accepted clinical indications are listed in Table 1(see appendices). Some benefits of mobile spirometry have been decreased time in with the exams; however it also has been a disadvantage for wait time in between patients due to the cleaning time. Also a disadvantage has been when the laptop dies in the middle of an exam. This has led to acquiring a mobile spirometry that actually connects to the electronic medical records (EMR). This has cut down on having a cart, laptop, cleaning time has decreased, and time between exams has decreased for an overall patient risk decrease and patient satisfaction. Hand-held office spirometers have been developed in recent years, with a global quality and user-friendliness that makes them acceptable for use in general practices. The precision of the forced vital capacity measurements could be improved (derom, 2008).
Some short term benefits would be that we can measure the benefits of changing spirometry procedure to a mobile spirometry. We could easily measure the changes and see if it truly is beneficial to decreasing patient risk and increasing patient satisfaction.
Some long term benefits would be a continued change in patient satisfaction and a continued decrease risk with patient spreading bacteria’s such as Pseudomonas Aeruginosa. Pseudomonas is highly contagious to someone who is immunocompromised such as a Cystic Fibrosis patient who would greatly benefit from a mobile spirometry (miller, 2005). Ultimately we would be able to see the long term effects of changing the system to a mobile spirometry. Some more long term goals would be improvement of Press Ganey scores which is patient satisfaction. The response rate forwidely-used outpatient satisfaction metrics and variables influencing the probability of survey nonresponse remain largely unknown (tyser, 2016)
The Faculty Group Practice (FGP) is in charge of all of the departments and they oversee each department when it comes to finances, patient satisfaction, and risk management. They would work with the department manager on quarterly goals to make sure everything stays on track. The quarterly meetings would compare the last quarters Press Ganey scores, microbiology cultures. The clinical ambulatory patient experience is heavily influenced by time spent waiting for provider care. Not only are metrics regarding the likelihood to recommend and the overall satisfaction with the experience negatively impacted by longer wait times, but increased wait times also affect perceptions of information, instructions, and the overall treatment provided by physicians and other caregivers (bleustein, 2014).
Department manager would be in charge of continuing to order the supplies need to perform the daily tasks. They would also monitor the patient satisfaction and do risk assessments by doing microbiology testing on the equipment and also culturing patients (which is a routine thing for Cystic Fibrosis patient).
The allied staff that would be in charge of the mobile spirometry can be a Spirometry certified Medical Assistant, a Respiratory Technician; even a Spirometry certified Registered Nurse can perform the task. They would be in charge of maintaining the equipment, reporting if anything is incorrect or a possible risk that has happened. They would directly report to their department manager.
At our conclusion with mobile spirometry it is a beneficial change, it has decreased the risk of cross contamination, improved Patient satisfaction, Press Ganey scores improved from 80% to 96%, decreased the time between exams, overall the exam went from 108 minutes to 69 minutes for each exam (this includes from rooming the patient, vitals, spirometry being performed, nurse intake, seeing the provider, ancillary staff seeing the patient and then to the discharge of the patient). Continued quarterly cultures have come back clean – no cross contamination between patients. It has now been recognized by the Cystic Fibrosis Foundation as a recommended technique when taking care of patients. Ultimately everyone’s goal is to make sure the risk has been decreased and patient satisfaction is continuing to improve.
Wilde M, Nair S, Madden B. Pulmonary function tests-a review. Care of the Crit Ill. 2007;(6):173–7.Dec 23.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.
Enright P. Flawed interpretative strategies for lung function tests harm patients. Eur Respir J 2006;27(6):1322–23 doi: 10.1183/09031936.06.00009006.
Derom, E., Weel, C. V., Liistro, G., Buffels, J., Schermer, T., Lammers, E., . . . Decramer, M. (2008, January 01). Primary care spirometry*. Retrieved from https://erj.ersjournals.com/content/31/1/197
Tyser, A. R., Abtahi, A. M., McFadden, M., & Presson, A. P. (n.d.). Evidence of non-response bias in the Press-Ganey patient satisfaction survey. BMC HEALTH SERVICES RESEARCH, 16. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-016-1595-z
Bleustein, C., MD, MBA, Rothschild, D., BS, & Valen, A., MHA. (2014, May 20). Wait Times, Patient Satisfaction Scores, and the Perception of Care. Retrieved July 10, 2019, from https://www.ajmc.com/journals/issue/2014/2014-vol20-n5/wait-times-patient-satisfaction-scores-and-the-perception-of-care