Bedside spirometry in a tertiary care hospital: the cleveland clinic experience

In contrast to outpatient, laboratory testing, which is performed by a small, dedicated group of pulmonary function technologists, inpatient, bedside spirometry at the Cleveland Clinic Hospital is performed less frequently and by a larger group of respiratory therapists with broader responsibilities. A 1998 audit of bedside spirometry tests at our hospital showed that American Thoracic Society acceptability and reproducibility criteria were infrequently met (15% of instances).

To address that shortcoming, we initiated an improvement plan for bedside spirometry that included: (1) A didactic review of American Thoracic Society acceptability and reproducibility criteria that was videotaped and reviewed by all but one of the therapists performing spirometry; (2) limiting the number of operators to a "core group" to allow more tests per therapist; (3) producing printouts of the pulmonary function tests, which allows immediate review of volume-time and flow-volume curves; (4) central review of all tests by a pulmonary function technologist and feedback and constructive suggestions on test quality and reproducibility to operators. After initiating the program we performed a consecutive survey of all inpatient spirometry sessions performed from July 16, 1998, to March 2, 1999.

During the survey period, 63.5% of the tests (n = 137) were deemed acceptable, exceeding the low baseline rate of 15% (p < 0.001). Values for forced expiratory volume in the first second were reproducible in 83.9% of sessions. Values for forced vital capacity were reproducible in 80.3% of sessions.

A quality improvement program for bedside spirometry testing that emphasizes training and routine feedback on test quality can enhance the quality of inpatient spirometry testing.