Abstract Rationale Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the leading causes of potentially preventable hospitalization. Prolonged hospitalizations consume healthcare resources, decrease quality of life, and are associated with increased morbidity and mortality. At our center, the mean length of stay (LOS) for COPD hospitalizations during fiscal year 2025 was 5.49 days, higher than comparable institutions using Vizient Quality and Accountability study data. We conducted multidisciplinary stakeholder interviews and performed a qualitative analysis to understand stakeholders’ perspectives on reducing the LOS for COPD admissions at a single academic medical center. Methods Stakeholders interviewed included resident physicians, advanced practice providers, social workers and case managers, clinical nurse leads, respiratory therapists (RTs), sleep medicine consultants, and pulmonology consultants. Semi-structured interviews were conducted to understand stakeholders’ roles, interdisciplinary communication, factors contributing to effective care during the admission, safe discharge coordination, and bottlenecks contributing to prolonged LOS. Themes on modifiable factors leading to prolonged hospitalization were identified by a single reviewer. Results Themes from 13 stakeholder interviews were summarized in Table 1. Factors that were noted frequently across multiple disciplines included: (1) patient anxiety and dyspnea preventing discharge possibly due to fragmented education on symptom control, (2) delays in obtaining durable medical equipment including non-invasive ventilation and home oxygen possibly due to untimely blood gas collection and ambulatory oxygen saturation testing, (3) delays in goals of care conversations for patients with end-stage COPD, and (4) delays in nebulized bronchodilator de-escalation possibly due to variability in RT staffing and limitations in the de-escalation protocol. Conclusion We identified several areas of practice variability that are likely contributing to prolonged hospitalizations for patients admitted with COPD exacerbation at our center. Future work will focus on incorporating patient perspectives on LOS, and ultimately identifying and implementing interventions to prevent prolonged hospitalizations. Potential high impact, low effort interventions include early and standardized counseling on symptom management, and primary team or palliative care driven goals of care conversations for patients with end-stage COPD. A high impact, high effort intervention could include an inpatient clinical pathway addressing the above bottlenecks and providing more efficient allocation of resources - ultimately improving health outcomes in this population. This abstract is funded by: None
Gheewala et al. (Fri,) studied this question.