Improving spirometry recording for your COPD patients

What is the aim of this QI activity?

The aim of this QI activity is to: 

• to improve the use of spirometry to inform diagnosis of COPD

• identify 10 COPD patients missing a recorded spirometry result and ensure results are documented or patients are recalled for spirometry.

• support evidence-based COPD management

What will I need to do?

• run a Primary Sense report to identify COPD patients without recorded spirometry

• review patient clinical records

• source spirometry results completed externally, where applicable

• recall suitable patients for spirometry testing

How will I complete this activity?

• recall identified patients to attend spirometry with the Practice Nurse or GP

• perform and record spirometry results in the clinical system

• upload external spirometry results into the patient record once received

Where do I document my results?

• QI summary register

• Model for improvement/PDSA template

Who can I contact for support?

For support with this activity please contact the General Practice Quality Improvement team on 38647540 or email [email protected].

1.  Identify patients with COPD that are missing a recorded spirometry.

Using Primary Sense, run the Chronic Lung Disease and Asthma report.

Using the search function, search for COPD or Chronic Obstructive Pulmonary Disease (depending on how your practice codes the condition). This will filter the report to those patients with a COPD diagnosis coded in their patient record.

The column titled ‘Spirometry’ can be used to identify patients who do not have a spirometry recorded in their clinical record.

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2 - Review clinical records

Once you have identified ten patients who do not have a spirometry recorded in the above report, you can then review each clinical record to check:

• are there any results under the ‘in-correspondence/results’ section as a PDF or image?

• has the GP indicated in ‘free text’ that a spirometry had been completed elsewhere?

If spirometry is performed internally, some clinical software will directly import the results into the appropriate fields. If this does not occur and you must enter results manually, please consult your software provider's manual:

• SpiroUSB Spirometer

• MD Help

• Respiratory Function

• Best Practice Clinical Functions – Respiratory Function

• Connect a medical device

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3. Set up recalls and/or prompts for patients

The Spirometry Handbook for primary care and the COPD-X Handbook provide clinical guidance on the use of spirometry for the diagnosis of COPD and monitoring. For your identified patients with COPD, where it is confirmed that no spirometry has been noted, discuss the findings with their regular GP. Confirm with the patient’s regular GP prior to recalling the patient to book in for spirometry or referral to a Respiratory service to perform the spirometry externally.

4. Document and share your results

You can document your results in the QI summary register or MFI/PDSA templates and display them in the treatment room or lunchroom so that team members can see the impact of their changes.

Suggested measures and data sources

• re-run the Chronic Lung Disease and Asthma Primary Sense report as shown above and compare updated spirometry entries.

or

• manually record the number of COPD patients identified as missing a spirometry and the number of patients that have since had spirometry records updated and/or spirometry performed.

• As a team, reflect on how the activity went.

• what were the challenges/barriers?

• what worked well?

• are there any small changes that you could implement to continue improving your recorded spirometry rates?

• share your results with your team and Brisbane South PHN (you can do this by clicking on the I’ve completed this activity button below).

• as next steps you might like to start Improving pneumococcal and influenza vaccination rates for patients with COPD | Brisbane South PHN

Example PDSA - Improving the use of spirometry for the diagnosis and management of COPD