Implementing evidence‐based guidelines: inpatient management of chronic obstructive pulmonary disease

Abstract

Recommendations for steroid initiation and avoidance of aminophylline are well adhered to. Concordance rates for other recommendations were generally less than 60%. Concordance with recommendations for steroid duration was significantly improved by our intervention. The findings suggest that to facilitate evidence-based practice, alternative interventions should be evaluated.

Frequency of referral to and attendance at a pulmonary rehabilitation programme amongst patients admitted to a tertiary hospital with chronic obstructive pulmonary disease

“…During the index hospital admission, 16% of people with COPD as the primary reason for their admission were referred for rehabilitation. This referral rate is identical to that reported 10 years previously in a different Australian hospital, from a review of 45 COPD patients . Similarly, two UK studies reported referral to rehabilitation at the time of admission as 3% (42/1400 patients) and 18% (9/50 patients) .…”

Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines

“…With the exception of Lindenauer et al. all studies indicated that ABGs included pH, PaCO 2 , PaO 2 analyses; three studies also included SaO 2 in their ABG analyses [15,18,21]. ABGs were performed in 44–84% of patients, with performance rates varying 20% across the hospitals that participated in the Roberts et al.…”

Multicentre audit of inpatient management of acute exacerbations of chronic obstructive pulmonary disease: comparison with clinical guidelines

“…The mode of such an intervention is also problematic. In a previous Australian study in COPD management an educational‐based intervention directed to medical staff disappointedly failed to improve concordance rates for most aspects of management studied 13 . As COPD management is multidisciplinary this raises the question of whether educational interventions targeted at nursing and allied health staff in addition to medical staff might not provide improved outcomes.…”

“…In an evaluation of over 8000 admissions for AECOPD across the UK wide variation in provision of care was found 11 . While an audit of COPD admissions to a single New Zealand hospital found that guidelines were well followed, 12 similar audits in single Australian hospitals found suboptimal and wide concordance rates for a variety of treatment recommendations 13,14 …”