Introduction National audit reports high rates of early readmission following hospitalisation for chronic obstructive pulmonary disease (COPD) exacerbation. Discharge bundles aim to optimise care and reduce readmission. Frimley Park Hospital NHS Foundation Trust interacts with different community respiratory teams across three counties.
Aims We hypothesised that a novel COPD discharge bundle would reduce re-admission. We also wished to see if the bundle was effective across multiple community administrations, and in patients with a history of frequent exacerbation.
Methods Admissions with a primary COPD diagnostic code and cases referred to the COPD nurse were collated during Q4 2013/14. Patients were classified according to whether they were assessed by the COPD nurse using the discharge bundle. Readmissions within 30-days and 3-months were identified using a hospital clinical database. Readmissions with COPD exacerbation (infective or non-infective) were included, as well as COPD associated lower respiratory tract infection or pneumonia. The database identified frequent severe exacerbators (patients with >1 admission in the previous year), and recorded age and length of stay as surrogates of disease complexity.
Results 24 patients were excluded (18 had other diagnoses, 4 died, and 2 lived out of area). Table 1 shows the characteristics of the remaining 156 patients according to whether they completed the bundle. There was no overrepresentation of short (zero or one day) length of stay patients in the group not completing the bundle. 17.5% of patients completing the bundle were re-admitted within 30-days, compared to 34% who did not (p = 0.027). A similar trend was seen at 3-months. No difference was observed in the timing or duration of readmissions. Logistic regression using covariates of age, length of stay, history of frequent severe exacerbation and discharge bundle use, suggested the latter two variables were both independent predictors of re-admission at 30-days: OR 5.70 (95% CI 2.46 to 13.2, p < 0.001) and OR 0.33 (95% CI 0.14 to 0.79, p = 0.012) respectively. Different community teams exerted no significant effect when added to the model.
Discussion Two-thirds of patients completed a discharge bundle during the Trust’s busiest quarter for COPD admission. Patients completing the discharge bundle had a significantly lower rate of 30-day readmission.
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