COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

Abstract

IntroductionCOPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care.MethodsWe conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22) versus those treated without the care bundle (controls; N=22).ResultsMean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001), 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001), and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003) decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value =0.044). Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001), 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005), and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015) seen in the care bundle cases.ConclusionOur significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial burden hospitals face in regard to this increasingly prevalent disease.

Performance of the LACE index to predict 30-day hospital readmissions in patients with chronic obstructive pulmonary disease

“…A postdischarge care bundle plan applied to a cohort of 44 COPD patients found the intervention group to have a 30-day readmission rate of 9.1% compared to 54.5% in the control group. 32 Two other studies also demonstrated a decrease in 30-day readmissions when utilizing care bundles, 14.7% from 22.7% 33 and 15.4% from 17.4%. 34 However, not all interventions work.…”

The use of a standardized order set reduces systemic corticosteroid dose and length of stay for individuals hospitalized with acute exacerbations of COPD: a cohort study

“… 13 – 15 Two recent studies also showed a reduction in LOS with implementation of EHS-based COPD order sets. 13 , 30 These interventions mainly focused on improving adherence to the multidisciplinary components of the order set to reduce LOS and avoid prescription errors rather than promoting a tailored corticosteroid regimen. However, our focus was to educate providers and reduce the corticosteroid dosing by encouraging the use of PowerPlan.…”

Costs of Treatment of Severe COPD Exacerbation in Serbia

“…These conditions present acute events leading to worsening of symptoms beyond the usual daily variations and are a major cause of morbidity and mortality (4). They accelerate the decline in lung function and thus promote the frequent use of medications, visits to the clinics and greater health care costs (5)(6)(7). The significant health and economic consequences of COPD exacerbation are still challenging for health care systems worldwide.…”