OBJECTIVES:Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation.
MATERIAL AND METHODS:From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS.
RESULTS:Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care.
CONCLUSION:Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals.
KEYWORDS:Chronic obstructive pulmonary diseases, length of stay
INTRODUCTIONChronic obstructive pulmonary disease (COPD) is a common chronic disease in the UK with a likely prevalence of 3 million people or 4% of the population [1]. Episodic exacerbations are usual and often require hospital admission. COPD exacerbation is the second most common reason for emergency admission to hospital behind circulatory disease and is associated with considerable risks of re-admission, death, and expense. Each COPD hospital admission is estimated to cost NHS commissioners £1960 [2].Estimates of typical length of stay (LoS) vary in the published literature. A British Thoracic Society study found a mean value of 7.1 days, whereas in Norway, it was 8.9 days, and a study in Blackpool reported 9.8 days [3][4][5]. Importantly, there is significant variation across England and Wales between many aspects of service provision and clinical outcomes for patients with respiratory disease. The NHS Atlas of Variation in Healthcare 2010 highlighted a four-fold variation in hospital bed-days occupied by COPD patients [6]. In London, there is a variation in LoS between hospitals by nearly 5 days [7]. Those patients with long LoS also occupy disproportionately more bed-days, and 50% of bed-days have been shown to be occupied by the minority of patients who stay at least 11 days [8]. Previously described associations of long LoS in COPD include poor organization of care, lack...
