Pre-hospital and emergency department pathways of care for exacerbations of chronic obstructive pulmonary disease (COPD)

Sneath, Emily; Bunting, Denise; Hazell, Wayne; Tippett, Vivienne; Yang, Ian A.

doi:10.21037/jtd.2019.10.37

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Lastly, we found that patients arriving in the ED by ambulance had a higher hospitalization rate. Again, this may reflect disease severity, as an Australian study has found that 78% of AECOPD patients who arrived by ambulance were admitted to the hospital, including 7% who were admitted to the intensive care unit [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010–2018

Liew

Hsu

et al. 2023

BMC Pulm Med

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Objectives Little is known about the recent status of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the U.S. emergency department (ED). This study aimed to describe the disease burden (visit and hospitalization rate) of AECOPD in the ED and to investigate factors associated with the disease burden of AECOPD. Methods Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010–2018. Adult ED visits (aged 40 years or above) with AECOPD were identified using International Classification of Diseases codes. Analysis used descriptive statistics and multivariable logistic regression accounting for NHAMCS’s complex survey design. Results There were 1,366 adult AECOPD ED visits in the unweighted sample. Over the 9-year study period, there were an estimated 7,508,000 ED visits for AECOPD, and the proportion of AECOPD visits in the entire ED population remained stable at approximately 14 per 1,000 visits. The mean age of these AECOPD visits was 66 years, and 42% were men. Medicare or Medicaid insurance, presentation in non-summer seasons, the Midwest and South regions (vs. Northeast), and arrival by ambulance were independently associated with a higher visit rate of AECOPD, whereas non-Hispanic black or Hispanic race/ethnicity (vs. non-Hispanic white) was associated with a lower visit rate of AECOPD. The proportion of AECOPD visits that were hospitalized decreased from 51% to 2010 to 31% in 2018 (p = 0.002). Arrival by ambulance was independently associated with a higher hospitalization rate, whereas the South and West regions (vs. Northeast) were independently associated with a lower hospitalization rate. The use of antibiotics appeared to be stable over time, but the use of systemic corticosteroids appeared to increase with near statistical significance (p = 0.07). Conclusions The number of ED visits for AECOPD remained high; however, hospitalizations for AECOPD appeared to decrease over time. Some patients were disproportionately affected by AECOPD, and certain patient and ED factors were associated with hospitalizations. The reasons for decreased ED admissions for AECOPD deserve further investigation.

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Section: Discussionmentioning

confidence: 99%

Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010–2018

Liew

Hsu

et al. 2023

BMC Pulm Med

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“…If our results confirm this benefit, we also would like to underscore the importance of training physicians and nurses on the specific medical and care protocols required by patients with ACOPD and APE as already reported in previous studies. 24,26…”

Section: Discussionmentioning

confidence: 99%

Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain

Garcia

Sanz

Gutiérrez-Misis

et al. 2021

Australian Critical Care

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Background: Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. Objectives: To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. Methods: This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and costeffectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. Discussion: This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. Conclusion:The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.

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“…39 A reported disjunct exists between holistic respiratory ward-based COPD clinical pathways and atomistic acute ED clinical pathways generally due to the difference in care focus, time constraints, national targets, and lack of human and fiscal resources such as beds, clinicians, staff, and high patient turnover (environmental context and resources). 11,15,23,40 Targeted speciality care order sets specifically designed for departmental needs and care focus such as in the ED is highly recommended for implementation. 11,15,41…”

Section: Diagnostic Utilisation Of Spirometry Abg and Oxygen Managementmentioning

confidence: 99%

Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review

Issac¹,

Moloney²,

Taylor³

et al. 2022

JMDH

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Background: COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. Materials and Methods: This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. Results: Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over-or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. Conclusion: Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance. Ethics and Dissemination: Ethical approval is not required, and results dissemination will occur through peer-reviewed publication. PROSPERO Registration Number: CRD42020156267.

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Pre-hospital and emergency department pathways of care for exacerbations of chronic obstructive pulmonary disease (COPD)

Cited by 7 publications

References 33 publications

Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010–2018

Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010–2018

Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain

Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review

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