Article Text

UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation
Free
  1. L C Price1,
  2. D Lowe2,
  3. H S R Hosker2,
  4. K Anstey2,
  5. M G Pearson2,
  6. C M Roberts2,
  7. on behalf of the British Thoracic Society and the Royal College of Physicians Clinical Effectiveness Evaluation Unit (CEEu)
  1. 1St George’s Hospital, London, UK
  2. 2Royal College of Physicians Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, UK
  1. Correspondence to:
    Professor C M Roberts
    Chest Clinic, Whipps Cross University Hospital, London E11 1NR, UK; michael.roberts{at}whippsx.nhs.uk

Abstract

Background: Acute chronic obstructive pulmonary disease (COPD) exacerbations use many hospital bed days and have a high rate of mortality. Previous audits have shown wide variability in the length of stay and mortality between units not explained by patient factors. This study aimed to explore associations between resources and organisation of care and patient outcomes.

Methods: 234 UK acute hospitals each 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. Inpatient mortality was 7.4% and mortality at 90 days was 15.3%; the readmission rate was 31.4%. Mean length of stay for discharged patients was 8.7 days (median 6 days). Wide variation was observed in all outcomes between hospitals. Both inpatient mortality (odds ratio (OR) 0.67, CI 0.50 to 0.90) and 90 day mortality (OR 0.75, CI 0.60 to 0.94) were associated with a staff ratio of four or more respiratory consultants per 1000 hospital beds. The 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 hospital 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.

  • COPD, chronic obstructive pulmonary disease
  • FEV1, forced expiratory volume in 1 second
  • LOS, length of stay
  • chronic obstructive pulmonary disease
  • audit
  • resources
  • organisation of care
  • outcomes
View Full Text

Statistics from Altmetric.com

Supplementary materials

  • Files in this Data Supplement:

    • [view PDF] - Table: Patient case-mix factor associates of outcome.

Footnotes

  • Published Online First 31 January 2006

  • Central organisation at the Clinical Effectiveness and Evaluation Unit was funded by a grant from the British Thoracic Society’s COPD Consortium.

  • Competing interests: none declared.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Airwaves
    Wisia Wedzicha