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

Abstract

BACKGROUND: The majority of prescriptions for supplemental oxygen are written when patients are discharged to home from the hospital and the evaluation of these patients is inconsistent. Respiratory Therapists receive training in the evaluation and management of patients needing oxygen. The primary goal of the study was to estimate the frequency with which respiratory therapists (RTs) evaluate the need for home oxygen in patients hospitalized for COPD exacerbations before discharge. METHODS: An online questionnaire was distributed to RTs in the United States by the American Association for Respiratory Care. RTs were asked to indicate how frequently they evaluate the need for home oxygen on an ordinal scale: Never, Rarely/occasionally, Sometimes, Most of the time, Almost every time, or Every time. Consistent evaluation for home oxygen was defined as performing an evaluation for home oxygen therapy Almost every time or Every time (ie, > 75% of the time). Bivariate and multivariable analyses were assessed using the Fisher exact test and logistic regression models. RESULTS: Of 611 respondents, 490 were eligible for analysis. Fifty-eight percent of RTs reported consistently evaluating patients for home oxygen at rest, whereas 43% reported doing so during activity and 14% during sleep. Consistent evaluation for home oxygen requirements at rest was significantly associated with more years of practice (P 5 .03; highest among RTs with 6 30 y of practice at 40%), region of practice (P 5 .001; highest in the Midwest at 44%), and greater familiarity with criteria for home oxygen (P < .001; highest among RTs who selected Very familiar with guidelines from the Centers for Medicare and Medicaid Services at 58%). Practice in the Midwest and greater familiarity with criteria for home oxygen was associated with consistent evaluation for home oxygen during activity. Practice in the Midwest (vs Northeast; adjusted odds ratio 2.56, P < .001) and being very familiar with home oxygen criteria (vs not at all familiar; adjusted odds ratio 5.66, P < .001) were independently associated with a higher odds of evaluating for home oxygen at rest and with activity. Only 25% of RTs were involved in making decisions about home oxygen equipment. CONCLUSIONS: RTs do not consistently evaluate patients hospitalized for COPD exacerbations for home oxygen prior to discharge, and only a minority of RTs are involved in selecting home oxygen equipment.

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

“…Having a respiratory therapist routinely assess patients admitted with an exacerbation of COPD prior to discharge for both resting and exertional oxygen requirements is a potential solution to this problem; the survey data suggest it is already being done in many institutions. 3 Since only 42% of surveyed respiratory therapists stated they were very familiar with Centers for Medicare and Medicaid Services guidelines for home oxygen, additional education would be required.…”