Designing and implementing a COPD discharge care bundle

Hopkinson, Nicholas S; Englebretsen, Catherine; Cooley, Nicholas; Kennie, Kevin; Lim, M.C.; Woodcock, Thomas; Laverty, Anthony A; Wilson, Sandra R.; Elkin, Sarah; Caneja, Cielito; Falzon, Christine; Burgess, Helen A.; Bell, Derek; Lai, Dilys

doi:10.1136/thoraxjnl-2011-200233

Cited by 93 publications

(105 citation statements)

References 4 publications

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“…The Hillingdon respiratory outreach team routinely use a chronic obstructive pulmonary disease (COPD) discharge bundle3 and provide post discharge telephone and home support for 14 days. PR is fully commissioned and is provided by Harefield Hospital on an outpatient basis through three sites across the borough.…”

Section: Methodsmentioning

confidence: 99%

Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence

Jones

Green

Clark

et al. 2013

Thorax

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166

139

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Rationale Several randomised controlled trials support the provision of early pulmonary rehabilitation (PR) following hospitalisation for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, there is little real-world data regarding uptake, adherence and completion rates. Methods An audit was conducted to prospectively document referral, uptake, adherence and completion rates for early posthospitalisation outpatient PR in Northwest London over a 12-month period. Results Out of 448 hospital discharges for AECOPD, 90 referrals for post-hospitalisation PR were received. Only 43 patients received and completed PR (9.6% of all hospital discharges) despite a fully commissioned PR service. Conclusions Despite the strong evidence base, there are poor referral and uptake rates for early outpatient PR following hospitalisation for AECOPD, with only a small proportion of the intended target population receiving this intervention.

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Section: Methodsmentioning

confidence: 99%

Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence

Jones

Green

Clark

et al. 2013

Thorax

Self Cite

166

139

View full text Add to dashboard Cite

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“…Moreover the inclusion of a number of interventions into a discharge care bundle [30,31] has also been shown to reduce readmission rates. Identification of the risk factors highly associated with readmission rate would allow more vigorous post-discharge care bundles to be tailored for these patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes. @ERSpublications Hospital-admitted COPD exacerbation needs better risk stratification: spirometry and gas analysis improve outcomes http://ow.ly/RTbdk

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“…Innovative service improvements can save money as well as patients and are a motivation to engage managers and funders working with clinicians. We can also learn from other areas of medical practice where the ''care bundle'' concept has provided a mechanism with which to drive important care quality improvements notably in intensive care [4] and infection control [5] and now recently adopted in COPD [6].…”

Section: Statement Of Interestmentioning

confidence: 99%