Use of DECAF scoring system to facilitate early discharge in acute exacerbation of COPD patients: a quality improvement project at a district general hospital

Abstract

Introduction DECAF is a scoring tool that can predict severity in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0-1 are candidates for early discharge. Methods Plan, do, study, act (PDSA) methodology was used. Patients with AECOPD and a DECAF score of 0-1 were included. Notes were retrospectively reviewed for patients for DECAF score, length of stay, 30-day re-admission and 30-day mortality (PDSA cycle 1). A framework to facilitate early discharge for patients was subsequently established. Awareness was increased through teaching sessions, posters and targeted emails. To evaluate our improvements, the same parameters were collected prospectively (PDSA cycle 2). Results DECAF score was assessed for no patients in PDSA cycle 1 (n=20) but was assessed for all patients in PDSA cycle 2 (n=14). Hospital stay was significantly decreased in PDSA cycle 2 (mean 0.29±0.45 days) compared with PDSA cycle 1 (mean 3.71±2.69 days; difference p<0.00001). Thirty-day re-admission and 30-day mortality was not significantly different between two groups. Conclusion DECAF protocol is safe and feasible in the district general hospital setting and can facilitate early discharge for patients with low severity AECOPD without any worrisome effects.

How do we identify acute medical admissions that are suitable for same day emergency care?

“…68 Previous evidence suggests discharge with 'virtual ward' support may decrease readmissions in frail older adults; 69 however, this is compared to discharge with usual care and whether this approach could facilitate discharge in patients who would otherwise have been admitted was not assessed. Current evidence is limited to single centre, often observational studies [68][69][70] and evidence from large multicentre trials is lacking. Some centres have rapidly developed and implemented ambulatory pathways for patients with COVID-19, avoiding inpatient admission for those at low risk of deterioration.…”

An International Validation of the “DECAF Score” to Predict Disease Severity and Hospital Mortality in Acute Exacerbation of COPD in the UAE

“…Several studies validating the DECAF score have been conducted in the United Kingdom, 4 , 6 , 7 China, 8 , 9 Egypt, 10 and India. 11 Overall, the DECAF score has been shown to be effective and feasible in predicting mortality and early discharge in patients hospitalized with AECOPD.…”