Outpatient Respiratory Therapist Advocate Children's Hospital-OakLawn Oak Lawn, Illinois, United States
Background: In March 2020 the outpatient clinic and Pulmonary Function (PFT) lab at Advocate Children’s Hospital- Oak Lawn shut down. In April 2020 the center was notified about the distribution of home spirometers from a company working in collaboration with the Cystic Fibrosis Foundation. Traditionally, patients would be scheduled for spirometry prior to each clinic visit in order to reach the goal of four times per year. There was no ability to measure and monitor lung function for these patients. With the help of the CF List serve and our pulmonologist, Dr. Akhter, this virtual undertaking began. In May seven devices were ordered and shipped to the hospital. Patients were chosen based on severity of lung disease. Eventually, all patients six years of age and older were contacted with the opportunity to use a home spirometer.
Methods: Patients were contacted to introduce the home spirometer program. An instruction sheet was created that included an APP set up on a phone or tablet, device instructions, and cleaning/disinfecting steps. Instructions and nose-clips were included with the devise and sent to the patient via FedEx. Patients were instructed to download the recommended APP, clean the device, and schedule a virtual training session once the package was received. The initial virtual visit was lenghthy and required two devices: one with the APP installed to enable performing the test and one to visualize the patient perform the test. For a baseline reference, the last PFT that had been done in the PFT lab was used. The six-year-old patients did not have previous spirometry results. Patients were asked to perform two tests per week to reenforce technique and to e-mail a screen shot monthly. After reviewing screen shots with the pulmonologist, they were imported into the patient’s chart.
Results: The APP showed predicted values. In November 2021, the Provider Dashboard was initiated. With this platform, it is possible to update patient demographics, visualize patient efforts, and choose acceptable tests. The most recent function of the dashboard is the live coaching feature. A message can be sent directly to the patient’s phone or tablet notifying them of a requested live coaching session and results populate the dashboard. There is a recent consent active for sharing results directly with the CF Foundation. Although at this point it will not populate into Port CF. There were a few patients that were sent to the PFT lab because the validity of the test was in question. Those patients were encouraged to do a home test within a day or so for comparison. Those tests were almost identical in numerical value. From early May 2020 to April 2022: 44 spirometers have been sent to patients, 2 patients have not trained, 1 patient is deceased
Conclusions: Home spirometry produces accurate results with proper instruction on technique. Appointment time can be decreased if home spirometry has been done prior to clinic appointment. The ability to test at home is a patient satisfier. Patients are able to see current test results and trends on their device. Most importantly, home spirometry enabled the clinic to monitor patients’ lung function at a time when pulmonary function testing was not being done in clinic. Additionally, a dedicated Respiratory Therapist is crucial to the success of this task. Monthly reminder messages sent out via e-mail or health portal, daily review of patient results, scanning to patient chart, and follow through with live coaching sessions all require time.
.jpg "Pamela Peterson, RRT-NPS,CPFT,AE-C photo")