| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
1 St George’s Hospital, London, UK
2 Royal College of Physicians Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, UK
Correspondence to:
Correspondence to:
Professor C M Roberts
Chest Clinic, Whipps Cross University Hospital, London E11 1NR, UK; michael.roberts{at}whippsx.nhs.uk
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.
Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; LOS, length of stay
Keywords: chronic obstructive pulmonary disease; audit; resources; organisation of care; outcomes
Relevant Article
Thorax 2006 61: 831.
This article has been cited by other articles:
|
|
 |
|
  Sleep disordered breathing and respiratory failure (runs on into txdec08abs10) Thorax, December 1, 2008; 63(Suppl_7): A149 - A156. [Full Text] [PDF]
|
|
|
|
 |
|
 C J C Taylor, M F Murphy, D Lowe, and M Pearson Changes in practice and organisation surrounding blood transfusion in NHS trusts in England 1995-2005 Qual. Saf. Health Care, August 1, 2008; 17(4): 239 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Lusuardi, D. Orlandini, M. K. Han, and F. J. Martinez Underutilization of Spirometry for the Diagnosis of COPD Chest, January 1, 2008; 133(1): 313 - 314. [Full Text] [PDF]
|
|
|
|
 |
|
 S. I. Rennard and T. Higenbottam Exacerbation-Free COPD: A Goal Too Far? Proceedings of the ATS, December 1, 2007; 4(8): 583 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rudolf COPD and death: what exactly is the relationship? Thorax, May 1, 2007; 62(5): 378 - 379. [Full Text] [PDF]
|
|
|
|
|
|
P M A Calverley Caring for the burden of COPD. Thorax, October 1, 2006; 61(10): 831 - 832. [Full Text] [PDF]
|
|
|
|
|
|
M J Connolly, D Lowe, K Anstey, H S R Hosker, M G Pearson, C M Roberts, and on behalf of the British Thoracic Society and the Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: effect of age related factors and service organisation Thorax, October 1, 2006; 61(10): 843 - 848. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
