Audit of acute admissions of COPD: standards of care and management in the hospital setting

Abstract

There were large variations between centres for many of the variables studied. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management arterial blood gases were performed in 79% (interhospital range 40 -100%) of admissions and oxygen was formally prescribed in only 64% (range 9 -94%). Of those cases with acidosis and hypercapnia 35% had no further blood gas analysis and only 13% received ventilatory support. Long-term management was also deficient with 246 cases known to be severely hypoxic on admission yet two-thirds had no confirmation that oxygen levels had returned to levels above the requirements for long-term oxygen therapy. Only 30% of current smokers had cessation advice documented.To conclude, the median standards of care observed fell below those recommended by the guidelines. The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for improvement. The substantial variation in the process of care between hospitals is strong evidence that it is possible for other centres with poorer performance to improve their levels of care. Chronic obstructive pulmonary disease (COPD) has a high prevalence and is one of the most common causes of emergency medical admission with a respiratory disorder in the UK [1,2]. Several national and international Thoracic Bodies have produced management guidelines [3 -7] but relatively little is known about the standards of care of COPD as practised. Published studies encompass few hospitals, small patient numbers, and are not measured against nationally agreed standards. For example data from a sample of l00 cases from the West of Scotland suggested that care by respiratory specialists was better than that given by generalists [8]. A study from a single New Zealand hospital concluded that process of care was "adequate" measured against a local consensus view [9]. Following the launch of the British guidelines [7] the British Thoracic Society (BTS) performed an audit of the clinical practise of hospital care of patients admitted with acute exacerbations of COPD. The aims of the audit were to establish data on the current management of acute COPD in UK hospitals judged against the British guidelines and to identify differences in management between respiratory and nonrespiratory specialists. MethodsHospitals within the UK with acute Respiratory Medicine Departments were approached to participate in the study. All were asked to complete retrospective audit sheets from information held in case-note records on 40 consecutive admissions from September 1, 1997 with a clinical diagnosis of acute exacerbation of COPD as the admission criterion. The audit proforma developed by the BTS audit group, comprised 38 questions some with two or more stems covering the following areas of care: 1) background information and history prior to admission; 2) assessment and measurements on admission; 3) initial management; 4) continuing management and ...

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

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Early versus Late Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbations: A Randomized Trial

“…Exacerbations have detrimental effects on the patient’s health status and prognosis and the cost implications are enormous [16,17,18,19,20]. Unfortunately, most COPD research focuses on the acute treatment of exacerbations or on the long-term management of COPD.…”

Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study

“…2,[7][8][9] We collected data from each patient's history, general examination, laboratory tests and a standardized 3-minute walk test, during which the patient walked at his or her own pace for 3 minutes, regardless of distance. [10][11][12][13] Patients could use their normal walking aids but could not be supported by another person.…”