Discharge Checklist Targets COPD Readmissions: Reyleen Loreto, MD

When better inpatient care failed to bring down readmissions for chronic obstructive pulmonary disease (COPD), one hospital team turned its attention to the discharge process, according to Reyleen Loreto, MD. Presenting at CHEST 2026 in Phoenix, Arizona, Loreto described a quality improvement (QI) project built around a discharge checklist and a dedicated COPD navigator, which was associated with improved readmissions without longer hospital stays or more emergency department revisits.

COPD Inpatient Care to Discharge

The team had already encouraged providers to use a COPD order set, and orders increased, but readmissions remained high. “So if we are fixing the inpatient, maybe it’s time to look at the discharge process.”

Analyzing the discharge process revealed gaps in patient education, especially about medications, plus missed COPD navigator and pulmonary rehabilitation referrals and outpatient follow-up. Those findings shaped a checklist built around a set of questions: Does the patient understand the disease and when symptoms are concerning? Do they know what medications to take, and are those medications available at discharge? Do they know when to follow up?

At Loreto’s hospital, the COPD navigator is a respiratory therapist who ensures admitted patients have the order set, explains the disease with brochures and videos, and teaches inhaler technique, since many patients use inhalers incorrectly. The navigator also reviews prescribed steroids, antibiotics, and oxygen and coordinates care after discharge.

What Lowering Readmissions Means For Hospitals and Payers

As length of stay and emergency department revisits held steady, the team was not lowering readmissions by keeping patients in the hospital longer. Loreto acknowledged that the QI project does not prove causality, but she said it supports the value of a reliable discharge process for hospitals and payers. She advised other institutions to look beyond inpatient management and identify their own gaps. Her team plans to sustain the checklist with the navigator, nursing staff, and providers to keep COPD readmissions low.