The UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admissions for acute COPD exacerbation

Laura C Price ¹, Derek Lowe ², Harold Hosker ³, Katharine Anstey ², Michael Pearson ² and C Michael Roberts ^4*

¹ St Georges Hospital, United Kingdom
² RCP, United Kingdom
³ Airedale Hospital, United Kingdom
⁴ Whipps Cross University Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: michael.roberts{at}whippsx.nhs.uk.

Accepted 16 December 2005

Abstract

Background: Acute Chronic Obstructive Pulmonary Disease (COPD) exacerbations utilise many hospital bed days and have a high mortality. Previous audits demonstrated wide variability of length of stay and mortality between units not explained by patient factors. This study aimed to explore associations of resources and organisation of care with patient outcomes.

Methods: 234 UK acute hospitals prospectively identified 40 consecutive acute COPD admissions documenting process of care and outcomes from a retrospective case note audit. Units also completed a resources and organisation of care proforma.

Results: Data for 7529 patients were received. Mortality at 90 days was 15.3% (inpatient 7.4%), and readmission rate was 31.4%. Length of stay for discharged patients was mean 8.7 and median 6 days. Wide hospital variation in all outcomes was observed. Both inpatient (OR 0.67; CI 0.50-0.90) and 90-day mortality (OR 0.75; CI 0.60-0.94) were associated with a staff ratio of 4 or more respiratory consultants per 1000 hospital beds. Length of stay was reduced in units with more respiratory consultants, better organisation of care scores, an early discharge scheme and local COPD management guidelines.

Conclusions: Units with more respiratory consultants and better quality organised care have lower mortality and reduced length of stay. This may reflect unit resource richness. Dissemination of good organisational practice and recruitment of more respiratory specialists offers the potential for improved outcomes for hospitalised COPD patients.

Keywords: COPD, audit, organisation of care, outcomes, resources

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