Fev1 Indicated Exacerbation Score (FIES)

Kimberly Hodges, Dallas (Role: Co-Author), Amy Scott, Dallas (Role: Co-Author), Tanisha Bailey, Dallas, USA (Role: Co-Author)

BackgroundThe CF Clinic lacked standardization of the definition of severity, interventions, and treatments for patients with a pulmonary exacerbation. These variations in practice became evident during the COVID 19 pandemic when care teams were not seeing patients in person, and PFT’s stopped. In our center, we have multiple providers whose care practices are similar but not standardized. There was a need for a system that patients and staff members could better understand the “why” and next steps when patients were having an exacerbation. Earlier identification of exacerbation and intervention also was essential to avoid patients having a severe exacerbation. We joined the CFLN Fev1 Indicated Exacerbation Score (FIES) Innovation lab with AIM to design a real-time exacerbation signal process for patients.

MethodsSymptoms Indicated Exacerbation Score (SIES) scoring tool was created during the pandemic when PFT’s were halted. This symptom-based score replaces FIES when pulmonary function test (PFT) are not available or patient is unable to complete due to low lung function.

A FIES calculator was developed to easily formulate the patient’s individualized range of green, yellow, and red preestablished by the CFLN. The calculator uses the relative drop in FEV1% for FEV1’s greater than 50% and absolute drop in FEV1 for patients with FEV less than 50%. FIES scores are calculated prior to the appointment by the RT based on patient’s two highest FEV1 over the last year (admissions included).

Patient data was tracked on an excel database that includes FIES scores and home spirometry verses clinic.

Providers scored patient’s FIES and documented both in the After-Visit Summary and EPIC. Nursing and RT ultimately took over scoring and documenting due to missed scores.

Patient education on FIES scores was developed and reviewed by provider, RT, and reiterated by nurse at time of discharge.

Both the algorithm and Shared Decision Making (SDM) tool provided by the innovation lab was reviewed with patient for their feedback on their treatment plan. This SDM offers patients treatment options based on level of symptoms in collaboration with their provider. The plan may include patient to increase treatments, start antibiotics, or require admission.

Home spirometry supplied from the CF Foundation were distributed to n=149 patients, n=93 set up the device, and n=87 used it at least once. Home results are compared to PFT’s performed in clinic to confirm validity. It was found anthropometrics discrepancies was creating test variation. Process put in place to validate home heights and weights vs clinic by RT. Coaching offered face-to face by RT when patient technique is questionable.

ResultsFrom February 2020 through February 2021, 84% of eligible patients were screened this was short of our 95% goal. COVID19 clinic disruptions stopped PFT’s and FIES screening during March and April 2020. Eligible patient n=544 and screened for FIES n=413 with 66 yellow and 21 red FIES.

ConclusionOur goal is to continue to use the FIES tool as a standard of practice. Continued work is being done to validate home PFT’s to clinics. Additional studies on tracking admissions and antibiotic use are being followed. Working on standardizing follow up after antibiotic use is in progress.

FIES in the CF clinic