Objective: To implement measures to improve quality of care in Parkinson’s disease (PD) patients who are hospitalized at a large academic hospital with the goal of improving outcomes and reducing hospital length of stay.

Background: In the US, almost 300,000 patients with PD are hospitalized each year (1), often with prolonged length of stay compared to patients without PD (2). This may be in part due to errors in PD drug administration or use of contraindicated anti-dopaminergic medications (3). Lack of specialist care may also negatively affect outcomes (4).

Method: Starting in May 2022, we required pharmacists to review and adjust levodopa administration times based on personalized schedules. We also created a nursing education module to teach about PD and the importance of administering medications on time. We instituted a drug-disease alert that warns providers ordering anti-dopaminergic medications in a PD patient. To monitor the impact of these measures, we created an automated report that details any PD patient admitted to the hospital, their length of stay, whether a neurologist was consulted, whether their medications required a schedule adjustment by pharmacy, and when their medications were administered in relation to the scheduled time.

Results: From July 2021 (prior to our interventions) until June 2024, an average of 671 PD patients/year were admitted to the hospital. On average, 58% of patients were not being followed by a neurologist. 53% of patients required their levodopa prescription times to be customized during hospitalization, with a trend towards more accurate timing. Percentage of medications given on time increased from 54.5% in year 21-22 to 57.9% in 23-24, while percentage of medications given 16 or more minutes later decreased from 45.5% to 42.1%. The number of drug-disease alerts triggered per month ranged from 52 to 139, with a 31% average percentage of inappropriate drug orders cancellation. Length of stay did not significantly change during this time period.

Conclusion: Our quality improvement interventions were effective in improving accuracy of levodopa ordering and administration, as well as reducing the inappropriate administration of contraindicated medications. Hospital length of stay did not change over this short follow up period. We plan to assign an advanced practice provider to supervise PD care when there is no neurologist on board.

References: 1) Azmi H, Walter BL, Brooks A, Richard IH, Amodeo K, Okun MS. Editorial: Hospitalization and Parkinson’s disease: safety, quality and outcomes. Front Aging Neurosci. 2024 Apr 4;16:1398947.
2) Low V, Ben-Shlomo Y, Coward E, Fletcher S, Walker R, Clarke CE. Measuring the burden and mortality of hospitalisation in Parkinson’s disease: A cross-sectional analysis of the English Hospital Episodes Statistics database 2009-2013. Parkinsonism Relat Disord. 2015 May;21(5):449-54.
3) Martinez-Ramirez D, Giugni JC, Little CS, Chapman JP, Ahmed B, Monari E, Wagle Shukla A, Hess CW, Okun MS. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson’s disease patients. PLoS One. 2015 Apr 17;10(4):e0124356.
4) Skelly R, Brown L, Fakis A, Kimber L, Downes C, Lindop F, Johnson C, Bartliff C, Bajaj N. Does a specialist unit improve outcomes for hospitalized patients with Parkinson’s disease? Parkinsonism Relat Disord. 2014 Nov;20(11):1242-7.

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