Needs Assessment and Identification of the Multifaceted COPD Care Bundle in the Emergency Department of a Tertiary Hospital in Nepal

Abstract

Purpose: Acute care of patients with exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED) is crucial, however not studied extensively in Nepal. The purpose of this study is to identify the opportunities for succinct measures to optimize the AECOPD care in ED with a multifaceted bundle care approach in a resource-limited setting. Methods: We conducted a prospective cross-sectional observational study as an initial baseline stage of the quality improvement project. Demographic data, clinical characteristics, the current diagnosis and treatment performances of AECOPD were recorded. The primary outcome measures were 30-day ED revisit and near-fatal events which were compared with other variables and performances with binary and logistic regression. The multidisciplinary team performed the root cause and Pareto analysis to identify the potential gaps in the AECOPD care. Results: The AECOPD performance measures were suboptimal. Written AECOPD emergency management clinical guidelines and advice regarding pulmonary rehabilitation were absent. Among the 249 AECOPD encounters, bilevel positive-airway pressure ventilation was started in 6.4%. At discharge, 11.8% and 39.7% were given oral steroids and antibiotics respectively; 2.2% were advised vaccination. Near-fatal events and 30-day revisit occurred in 19% and 38.2% of the encounters respectively. Those who required domiciliary oxygen had significantly higher 30-day revisits (OR=2.5; 95% CI=1.43-4.4; P value =0.001) as did those who were previously admitted (OR=1.98; 95% CI 1.11-3.59; P value =0.022). Those who had a 30-day revisit had increased near-fatal events (OR=2.86; 95% CI=1.362-6.18; P value =0.006). The opportunities for improving the ED care were identified and feasible interventions and their indicators are summarized for future implementation. Conclusion: The current COPD performance measures were suboptimal with high 30-day revisit and near-fatal outcomes. We suggest the urgent implementation of the enlisted feasible bundles-care involving multifaceted team and protocol-based management plans for AECOPD in a busy resource-limited ED.

A Systematic Review and Meta-Analysis of Tai Chi Training in Cardiorespiratory Fitness of Elderly People

“…VC is an indicator for the inspiratory reserve capacity, expiratory reserve capacity, and tidal volume of an individual [ 56 ]. VC is also used for the diagnosis of lung diseases such as chronic obstructive pulmonary disease (COPD) [ 57 ] and asthma [ 58 ]. Our results suggested that Tai Chi significantly increased the VC in individuals (WMD = 316.05, 95% CI: 239.74 to 392.35, P ≤ 0.001).…”

Impact of the COVID-19 Pandemic on Therapy and Outcome of Acute Exacerbations of Chronic Obstructive Lung Disease at the Emergency Department

“…The occurrence of acute exacerbation of chronic pulmonary disease (AECOPD) is a common cause for individuals seeking medical attention at the emergency department (ED) [ 1 ]. The urgency in providing rapid treatment arises from the high mortality associated with this condition [ 2 , 3 ]. Non-invasive ventilation support (NIV) has been established as a gold standard treatment for AECOPD over the last couple of years [ 3 ].…”

“…The urgency in providing rapid treatment arises from the high mortality associated with this condition [ 2 , 3 ]. Non-invasive ventilation support (NIV) has been established as a gold standard treatment for AECOPD over the last couple of years [ 3 ]. However, the advent of the COVID-19 pandemic in early 2020 ushered in practical challenges that impacted the implementation of this established treatment.…”