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Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease
  1. C M Roberts1,2,
  2. D Lowe1,
  3. C E Bucknall4,
  4. I Ryland3,
  5. Y Kelly5,
  6. M G Pearson1,3,
  7. On behalf of the British Thoracic Society Audit Subcommittee of the Standards of Care Committee and the Royal College of Physicians of London
  1. 1Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK
  2. 2Whipps Cross Hospital, London, UK
  3. 3Aintree Chest Centre, Liverpool, UK
  4. 4Hairmyres Hospital East Kilbride, Glasgow, UK
  5. 5University College, London, UK
  1. Correspondence to:
    Dr C M Roberts, Chest Clinic, Whipps Cross Hospital, London E11 1NR, UK;
    cmr{at}wxhchest.demon.co.uk

Abstract

Background: The 1997 BTS/RCP national audit of acute chronic obstructive pulmonary disease (COPD) in terms of process of care has previously been reported. This paper describes from the same cases the outcomes of death, readmission rates within 3 months of initial admission, and length of stay. Identification of the main pre-admission predictors of outcome may be used to control for confounding factors in population characteristics when comparing performance between units.

Methods: Data on 74 variables were collected retrospectively using an audit proforma from patients admitted to UK hospitals with acute COPD. Important prognostic variables for the three outcome measures were identified by relative risk and logistic regression was used to place these in order of predictive value.

Results: 1400 admissions from 38 acute hospitals were collated. 14% of cases died within 3 months of admission with variation between hospitals of 0–50%. Poor performance status, acidosis, and the presence of leg oedema were the best significant independent predictors of death. Age above 65, poor performance status, and lowest forced expiratory volume in 1 second (FEV1) tertile were the best predictors of length of stay (median 8 days). 34% of patients were readmitted (range 5–65%); lowest FEV1 tertile, previous admission, and readmission with five or more medications were the best predictors for readmission.

Conclusions: Important predictors of outcome have been identified and formal recording of these may assist in accounting for confounding patient characteristics when making comparisons between hospitals. There is still wide variation in outcome between hospitals that remains unexplained by these factors. While some of this variance may be explained by incomplete recording of data or patient factors as yet unidentified, it seems likely that deficiencies in the process of care previously identified are responsible for poor outcomes in some units.

  • chronic obstructive pulmonary disease
  • clinical audit
  • outcome
  • hospital admission
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Supplementary materials

  •  
    The following tables provide further details of the variables that were analysed and found not to add significantly to the already identified predictors of outcome.

    These are included on the web site but not within the full published text for the sake of brevity. They are not referred to in the current text document for this reason.

    [View/download PDF]
     

Footnotes

  • Conflict of interest: none.

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