Pulmonology Specialty Collaborative March Update

What You Need To Know

As part of our commitment to keeping the entire department informed, here is a brief update on the key initiatives and decisions from our February Pulmonology Specialty Collaborative meeting. 

The goal of this collaboration is to bring physicians together to solve clinical challenges and standardize Pulmonology care across the network.

Key Updates from Our March Meeting

1. Refining the Network-Wide NIV Policy

The group held a productive working session to refine and build consensus on key operational points of the new network-wide NIV policy.

• ICU Downgrades & Patient Handoffs: The collaborative is addressing the complex challenge of ensuring appropriate pulmonary consults are placed for patients who remain on the floor on a BIPAP order after being evaluated by an intensivist (e.g., for a rapid response) but are not admitted to the ICU.
• A New Safety Net: The policy already states that a mandatory pulmonary consult be placed; however, to support this, the group approved the development of a non-disruptive, 24-hour pop-up alert. This alert will serve as a reminder to place a consult if one is not already active, without causing the BIPAP order to expire and creating disruptive nighttime calls.

 2. Proposed Alert for SABA/LABA Therapeutic Duplication

The collaborative reviewed a proposal for a new Our Practice Advisory (OPA) to flag potential therapeutic duplication when standing (non-PRN) orders for short-acting beta-agonists (SABA) are placed for patients already on a long-acting beta-agonist (LABA)

• Enhancing Patient Safety: The discussion highlighted that while this combination is often used intentionally in acute exacerbations, the alert would serve as a valuable long-term safety measure to prevent chronic toxicity and potential cardiac side effects.
• Collaborative Decision: After discussing the patient safety risks, the group agreed that the benefits of patient safety outweigh the potential for alert fatigue and supported moving forward with the alert's development, with the intention to closely monitor its impact on workflow and override rates post-implementation.

 3. Status Updates on Other Key Initiatives

• Standardized ILD Lab Panel: The project has pivoted from exploring a complex order set back to creating a simplified lab panel. This decision was made after clarifying with our IT and lab teams that a non custom panel is a more direct and achievable path that avoids significant compliance roadblocks. The goal is to create a one-click panel that bundles all the necessary, existing ILD lab tests, making it easier and more efficient for providers to order. Next steps involve mapping the individual lab codes and seeking final clinical approval.
• Oxygen Ordering Standardization: Following our last discussion, IT has implemented the requested changes to the oxygen order set, including updating the medium flow cannula to a "minimum set liter flow." These changes are now being circulated to the collaborative for final review and approval before being moved into production.
• Thoracentesis Order Set: A new initiative has been introduced to improve the thoracentesis order set, based on feedback that the current set is difficult to use for outpatients and is missing desired tests. A document of the current order set is being circulated for the collaborative physicians comments and suggestions.

Who to Contact

Do you have a clinical challenge, a workflow issue, or an idea for standardization? Please reach out to any of the Collaborative Chairs or the Network Patient Safety & Quality (PS&Q) Team: Jillian Stevens (jillian.stevens@hmhn.org) and Diveena Davis (diveena.davis@hmhn.org). 

For any questions, please feel free to contact the Pulmonology Collaborative Chairs:

• Dr. Keith Brenner (keith.brenner@hmhn.org)
• Dr. Lisa Casale (lisa.casale@hmhn.org)
• Dr. Eric Costanzo (eric.costanzo@hmhn.org)

Thank you for your continued partnership in improving patient care