Noncompliant, smoker, stubborn were a few words that Rhonda Bilyeu used to associate with patients who had chronic obstructive pulmonary disease, or COPD.
"That's what was in my head, but you can't fix something until you understand something," said Bilyeu, a registered respiratory therapist at Saint Thomas Health in Nashville who spoke Friday at Erlanger's Heart and Lung Institute COPD Symposium.
Bilyeu, affectionately known as "Respiratory Rhonda," specializes in caring for patients with a variety of breathing problems, including COPD — a term used to describe progressive lung diseases including emphysema, chronic bronchitis and non-reversible asthma.
Since COPD is a chronic disease, it requires constant monitoring that can be difficult, confusing and costly for patients. When left untreated, the disease severely hinders breathing and can land patients in the emergency room gasping for air, which Bilyeu calls "drowning on dry land." Respiratory therapists, the "lifeguards" at the hospital, get these patients back on their feet, but too often the same patients get sick again and continue to cycle in and out of the hospital.
Tennessee has the third highest rate of COPD in the nation, with nearly 9 percent of the population affected, so Bilyeu was well versed in how to treat the disease. But when given the task of lowering Saint Thomas' high number of COPD hospital readmissions, she said the first step toward improving patient outcomes was to toss away stereotypes and understand the root problems.
She learned that a large number of patients were "noncompliant," meaning not following the doctor's orders or skipping meds, but not necessarily because they were defiant.
"Lots of times it came down to, 'I can buy milk for my grandbabies, or I can buy that inhaler.' Which one are you going to do?" she asked the audience.
Saint Thomas began ramping up education and outreach efforts for COPD patients and significantly reduced the hospital's readmissions of them from about 30 percent to 17 percent, which in turn saved the hospital $2 million.
"Although people focus on readmission numbers and the dollars that it saves, the reality is it's leading to better patient care," she said. "As we look for ways to keep them out of the hospital, we're looking at ways to keep them healthier."
Takesha Pratt, lead respiratory therapist navigator at Erlanger, said she enjoyed Bilyeu's emphasis on following up with patients after discharge and making sure they understand their disease before they leave.
"A lot of times they tell you they understand, but they really don't. So bringing yourself down to their level I think is a big help," Pratt said. "Once you enter into their space of trust they open up more and are accepting of the education and teaching we're trying to provide."
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.