Survey of early discharge schemes from the 2003 UK National COPD Audit

Quantrill, Simon; Lowe, Derek; Hosker, Harold; Anstey, Kathryn; Pearson, M; Roberts, C M

doi:10.1016/j.rmed.2006.08.022

Cited by 18 publications

(25 citation statements)

References 12 publications

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“…The readmission rate in our study was 25%, which is comparable to the 30% in previously published studies 9–11. Characteristics like age, smoking history and living situation of patients in our study were similar to those in studies from the UK 9–12 and to that of a survey on hospital-at-home services in British hospitals by Quantrill et al 27…”

Section: Discussionsupporting

confidence: 86%

Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: results of a randomised controlled trial

et al. 2012

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ObjectivesTo determine the effectiveness of early assisted discharge for chronic obstructive pulmonary disease (COPD) exacerbations, with home care provided by generic community nurses, compared with usual hospital care.DesignProspective, randomised controlled and multicentre trial with 3-month follow-up.SettingFive hospitals and three home care organisations in the Netherlands.ParticipantsPatients admitted to the hospital with an exacerbation of COPD. Patients with no or limited improvement of respiratory symptoms and patients with severe unstable comorbidities, social problems or those unable to visit the toilet independently were excluded.InterventionEarly discharge from hospital after 3 days inpatient treatment. Home visits by generic community nurses. Primary outcome measure was change in health status measured by the Clinical COPD Questionnaire (CCQ). Treatment failures, readmissions, mortality and change in generic health-related quality of life (HRQL) were secondary outcome measures.Results139 patients were randomised. No difference between groups was found in change in CCQ score at day 7 (difference in mean change 0.29 (95% CI −0.03 to 0.61)) or at 3 months (difference in mean change 0.04 (95% CI –0.40 to 0.49)). No difference was found in secondary outcomes. At day 7 there was a significant difference in change in generic HRQL, favouring usual hospital care.ConclusionsWhile patients’ disease-specific health status after 7-day treatment tended to be somewhat better in the usual hospital care group, the difference was small and not clinically relevant or statistically significant. After 3 months, the difference had disappeared. A significant difference in generic HRQL at the end of the treatment had disappeared after 3 months and there was no difference in treatment failures, readmissions or mortality. Early assisted discharge with community nursing is feasible and an alternative to usual hospital care for selected patients with an acute COPD exacerbation.Trial registration: NetherlandsTrialRegister NTR 1129.

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Section: Discussionsupporting

confidence: 86%

Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: results of a randomised controlled trial

et al. 2012

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“…European health systems have a large inter-hospital variability in terms of resources and the range of services offered [12, 13], and some previous reports have found a relationship between LOS and such factors [4, 14, 15], whilst others have not [16, 17]. To our knowledge, there has been no comprehensive analysis studying the effects of clinical, organisational and resource factors on LOS in European patients admitted with exacerbations of COPD across a range of European countries and healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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“…The findings from this observational audit suggest that SDPs for treating acute exacerbations of COPD are safe, reduce LOS and address queries raised by BTS guidelines 2. In the UK in 2008, 59% of units provided SDPs, a relative increase of 31% since the 2003 UK COPD audit 4. Overall 18% (33% in units with access to SDPs) of patients with COPD with acute exacerbations were accepted onto SDPs, supporting estimates from current BTS guidelines 2.…”

Section: Discussionmentioning

confidence: 77%

National audit of supported discharge programmes for management of acute exacerbations of chronic obstructive pulmonary disease 2008

Kastelik

Lowe²,

Stone³

et al. 2012

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The 2008 UK national chronic obstructive pulmonary disease (COPD) audit examined the use of supported discharge programmes (SDPs) in clinical practice against British Thoracic Society guidelines. 98% of acute UK trusts participated. SDPs were available in 142 of 239 (59%) units. 1630 of 8971 (18%) patients with COPD were treated within SDPs. Median (IQR) stay in hospital for patients within SDPs and those not accepted for SDPs was 3 (1e6) days and 6 (3e11) days (p<0.001), and mortality within 90 days of admission was 4.3% and 6.7%, respectively. SDPs within the UK are safe and effective and reduce length of hospital stay without adverse effects on mortality.

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Survey of early discharge schemes from the 2003 UK National COPD Audit

Cited by 18 publications

References 12 publications

Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: results of a randomised controlled trial

Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: results of a randomised controlled trial

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

National audit of supported discharge programmes for management of acute exacerbations of chronic obstructive pulmonary disease 2008

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