Evaluation and Documentation of Supplemental Oxygen Requirements is Rarely Performed in Patients Hospitalized With COPD

Abstract

Rationale:Patients hospitalized with chronic obstructive pulmonary disease (COPD) who require supplemental oxygen (O2) are at increased risk of hospital readmissions. There is a paucity of information regarding quality of evaluation and documentation regarding the need for supplemental O2 in this population. Objective: To determine the extent to which evaluation and documentation regarding the need for supplemental O2 occurs prior to hospital discharge in patients with COPD. Methods: We conducted a two-center retrospective cohort study of hospitalized adults with a physician diagnosis of COPD. We reviewed electronic health records to ascertain whether patients underwent evaluation beyond rest oximetry documenting hypoxemia and if there was adequate documentation of supplemental O2 requirements prior to discharge. Results: Of 526 patients hospitalized with a primary or secondary discharge diagnosis of COPD, 335 patients (mean age 69 years, 78% with diagnosis of COPD exacerbation) met eligibility criteria. Overall, 1 in 5 (22%, 73/335) hospitalized patients with COPD had an evaluation beyond rest oximetry for supplemental O2 requirements during admission. Adequate documentation of supplemental O2 requirements occurred in even fewer patients (16%, 54/335). Both evaluation (26% versus 5%, p=0.002) and documentation (19% versus 4%, p=0.001) of supplemental O2 requirements were more common in patients hospitalized for a COPD exacerbation compared to those hospitalized with COPD but without an exacerbation. Conclusions: Evaluation and documentation of supplemental O2 requirements beyond rest oximetry occur infrequently in patients hospitalized with COPD. AbstractAbbreviations: chronic obstructive pulmonary disease, COPD; oxygen, O 2 ; Centers for Medicare and Medicaid Services, CMS; Documentation and evaluation of Oxygen Requirements In COPD study, DORIC; electronic health records, EHR; forced expiratory volume in 1 second, FEV1; forced vital capacity, FVC; Global initiative for chronic Obstructive Lung Disease, GOLD; pulse oximetry, SpO2; LongTerm Oxygen Treatment Trial, LOTT; standard deviation, SD; against medical advice, AMA

Home Oxygen Evaluation by Respiratory Therapists in Patients Hospitalized for COPD Exacerbations: The RIsOTTO Study

“…[11][12][13] While it is possible that evaluation for home oxygen is performed by other clinicians besides RTs (eg, nurses, medical residents), a previous study in 2 hospitals indicates that gaps in evaluation for home oxygen are common. 3 In this previous study, only 22% (73 of 335) of subjects hospitalized with COPD had an adequate evaluation for home oxygen and only 16% (54 of 335) had adequate documentation of home oxygen requirements.…”

“…1,2 However, a recent study in subjects hospitalized for COPD exacerbations suggests that the evaluation of patients for home oxygen is inconsistent. 3 Moreover, patients with COPD report various concerns about home oxygen therapy following hospitalization, including malfunctioning oxygen equipment, lack of education about the use of the equipment, and inadequate access to appropriate home oxygen equipment. 4 Respiratory therapists (RTs) receive training in the evaluation and management of patients with COPD and other lung disorders (https://www.aarc.org, Accessed July 5, 2020).…”

Home Oxygen Therapy for Patients With COPD: Time for a Reboot

“…However, the details regarding the evaluation or prescription in the hospital are often poorly documented, missing altogether, or simply unavailable to the patient, their caregivers, and their out-patient clinician. 34 Also, patients initiated on home oxygen in the hospital often receive inadequate education about their options for home oxygen equipment and how to use the equipment, or they do not have appropriate, affordable access to the equipment that is right for them. 25 In the case of Mr Carter, a light-weight portable concentrator for ambulation may have been the best device.…”

Identifying an Important Ingredient for Safe Discharge to Home Oxygen Therapy: The Respiratory Therapist and the RIsOTTO Study

“…However, a recent retrospective study of subjects with COPD revealed that, while documentation of resting hypoxemia was good, evaluation for exertional hypoxemia was usually lacking. 2 Furthermore, documentation that prescribed oxygen was adequate during both rest and with exertion was also typically lacking. Hospitalists are extremely busy and often do not have control over their time as they have to address patients' acute needs.…”

“…Documentation that prescribed oxygen is adequate at rest is also usually present because oxygen saturation is recorded with the vital signs and these values are usually easily obtained from the electronic medical record, although the level of supplemental oxygen may be less carefully documented. However, assessment for exertional hypoxemia is usually not done as outlined in the retrospective review by Zaidi et al, 2 nor is an assessment of levels of supplemental oxygen required to prevent exertional hypoxemia. Assessment for nocturnal hypoxemia is rarely done prior to discharge.…”