Author(s): Lisa Silbert, MSN, ARNP-BC
Nurse Practitioner
Veterans Health Administration

Competency Domain: Performance & Process Improvement

Description: Use of spirometry in clinic to save time and money. Veterans with shortness of breath seen for Environmental Hazards at WRJ VAMC, recieved spirometry to assess vs automatic referral for PFTs. Done at same time as visit, if normal no PFTs needed. Reviewed by Pulmonologist to verify results of testing. Improved from 100% PFT referrals to 20% PFT referrals. Veterans did not have to return for a second visit and less PFT slots filled with veterans who would have normal PFT results. Problem:Streamline process, save time and money, free up slots for other veteransMeasurement:control charts, fishbone diagram, hypothesis testing. Analysis:CPK and control chartsImplementation:Implemented a clinic spirometry tool to assess breathing. Obstacles were equipment, knowledge of use of spirometer, getting consult read by pulmononogist, and results being shared with veteran. These were overcome by complex failure mode effect analysis (FMEA). They could implement and improve PFT referrals and lower costs and save time.Results/DiscussionImproved efficency for PFT referrals and veterans getting baseline documentation of breathing. It is sustained in our clinic we have two spirometers for the two providers, would like to spread.