Tran, Megan

Abstract Introduction: The variety of pulmonary function tests (PFTs) offered in the pulmonary function lab (PFL) can confuse providers unfamiliar with the clinical role of the individual components of the PFT, potentially leading to repeat tests, diagnostic delays, patient burden, and reduced lab efficiency. We hypothesized that a symptom- and diagnosis-based ordering set will reduce the need for repeat testing visits. Methods: Baseline data (June 2022-June 2023) were first collected to establish PFL performance benchmarks and identify common reasons for incomplete or repeat PFL visits. We then implemented an electronic order set reflecting the clinical need of the PFT, based on symptoms, diagnoses, suspected diagnoses, or other common clinical indication in addition to a physician-supervised, results-driven protocol to allow de-escalation of testing when appropriate The pre-implementation data was compared to the post-implementation data (July 2023-June 2024), evaluating for its impact on PFL access, utilization of the specific PFT components (e.g. methacholine challenge test, MCT), and on diagnoses. Results: During the study period 52,292 PFTs were performed during the pre-implementation phase compared to 58,310 tests in the post-implementation phase. Following intervention, the need for a second PFL visit for the same clinical indication decreased from 26% to 13% (p<0.0001). The same day PFL capacity increased by 3-4 patients per day. 80% of primary care providers reported the new order design was more intuitive and easier to use. Among the specific components of the PFT, there was a significant increase in the number MCTs being performed, from 2.5% to 4%, (p<0.0001), with a change rate ranging between 26 – 81% / month. In a subset analysis of 57 consecutive patients having MCTs, the primary indications were evaluation for cough or wheezing (57.9%), initial asthma evaluation (22.8%), and specifically requested by the ordering provider (19.3%). MCT was not performed in 23% due to a low baseline lung function, difficulty with repeatable efforts, recent bronchodilator administration, or due to complicating comorbidities. Of the 39 tests completed, 89% were deemed appropriate, with 32% having positive results and 42% ultimately diagnosed with asthma. Conclusions: A symptom and/or diagnosis guided ordering set for pulmonary function testing appears to improve the efficiency of the PFL, while improving provider experience, PFL access, as well as on patient burden and diagnoses. Further research is needed to determine potential benefits for provider decision-making and patient outcomes.