Cleveland Clinic's Parkinson Disease Inpatient Program Improves Patient Outcomes

A new study showed that the Cleveland Clinic (CCF)'s Parkinson's Inpatient Program was an efficient and effective way to successfully identify and prevent or correct common clinical errors that could lead to poor outcomes and increased complications in hospitalized patients with Parkinson disease (PD). Study authors noted that the impact of these achievements on patient outcomes such as discharge disposition and length of stay will be analyzed as intervention and data collection continues through the end of June 2024.¹

Conducted by lead author Patricia A. Clark, CNP, a nurse practitioner at Cleveland Clinic, and colleagues, all charts of patients with PD admitted at CCF's Main Campus and Fairview hospitals were prospectively pulled into a census utilizing a custom EHR tool starting in January 2023. After confirmation of PD diagnosis, researchers followed the patient’s charts throughout the admission. Authors monitored their charts for PD contraindicated (CI) medications, deviations from home PD medication regimen, worsening of motor and non-motor symptoms, and other complications. Investigators also noted that the PD Inpatient Team initiated active intervention when appropriate. Data for each patient admission and intervention performed was collected in a RedCap database.

The CCF Parkinson's Inpatient Program, in collaboration with the Parkinson's Foundation, comprises of system and patient level interventions aimed to prevent errors, avoid complications, manage symptoms, and promote recovery among patients with PD. System level interventions took place at both enterprise and individual hospital levels. Enterprise level changes included electronic health record (EHR) modifications including best practice alerts and notification of disease CI medications. Furthermore, hospital level interventions included creation of a PD inpatient census, a dedicated PD inpatient consult team, clinician education, changes in PD medication stocking/administration, and changes to Speech Therapy documentation templates.

Among 143 interventions for PD, researchers reported 24 (20%) related to ordering (9.0%) and/or administering (11%) of disease CI. Notably, 50 (43%) of the interventions adjusted to hospital MAR to match home PD medication schedule, and 47% of internvetions offered patients education and reassurance. Authors noted that "Other" reasons for intervention included deep brain stimulation therapy, Duopa management, and supplying PD specific recommendations for complications including nausea, dysphagia and psychosis.

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Presented at the 3rd Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 22-25, 2024, 200 admissions from 152 confirmed patients with PD who underwent the first 6 months of intervention between January and June 2023 were analyzed. Patients had an average age of 72.4 (SD, 9.9) years old and had an average length of stay of 3.1 days (range, 1.8-6.4). Authors noted that the primary reason for hospital admission was a planned procedure. The Inpatient Team identified the need for active involvement, beyond chart monitoring, for 122 (61%) of these patients. Moreover, active interventions incorporated phone or messaging patient's primary inpatient provider (43%) and in-person bedside visits (57%). Investigators reported that the mean time spent on an active intervention was 17 minutes (SD 9.2; range 5-60).

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REFERENCES
1. Clark PA, Brooks A, Fernandez HH, et al. Improving the Quality and Safety of Care for Hospitalized Patients with Parkinson's Disease. Presented at: ATMRD; June 22-25, 2024; Washington, DC.