Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study
Authors McCarthy C, Brennan JR, Brown L, Donaghy D, Jones P, Whelan R, McCormack N, Callanan I, Ryan J, McDonnell TJ
Received 13 August 2013
Accepted for publication 25 September 2013
Published 28 November 2013 Volume 2013:8 Pages 605—611
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Cormac McCarthy,1 John R Brennan,1 Lindsay Brown,1 Deirdre Donaghy,1 Patricia Jones,1 Rory Whelan,2 Niamh McCormack,3 Ian Callanan,4 John Ryan,2 Timothy J McDonnell1,3
1Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland; 2Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland; 3Clinical Strategy and Programmes Directorate, Health Service Executive, Dublin, Ireland; 4Department of Audit, St Vincent's University Hospital, Dublin, Ireland
Aim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD) care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes.
Introduction: The level of care provided in the emergency department (ED) for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs.
Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly.
Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P<0.001). There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003) and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003). Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054). The 30-day readmission rate did not significantly improve.
Conclusion: The use of a bundle improves the delivery of care for COPD exacerbations in the ED. There is more appropriate use of therapeutic interventions, especially oxygen therapy and intravenous corticosteroids.
Keywords: COPD, checklist, bundle, exacerbations, steroids
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]
Readers of this article also read:
Ongel EA, Karakurt Z, Salturk C, Takir HB, Burunsuzoglu B, Kargin F, Ekinci GH, Mocin O, Gungor G, Adiguzel N, Yilmaz A
Published Date: 17 October 2014
Adjunctive treatment with oral AKL1, a botanical nutraceutical, in chronic obstructive pulmonary disease
Brockwell C, Ampikaipakan S, Sexton DW, Price D, Freeman D, Thomas M, Ali M, Wilson AM
Published Date: 9 July 2014
Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis
DiSantostefano RL, Li H, Hinds D, Galkin DV, Rubin DB
Published Date: 7 May 2014
Parnell H, Quirke G, Farmer S, Adeyemo S, Varney V
Published Date: 30 April 2014
Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying
Høiseth AD, Omland T, Karlsson BD, Brekke PH, Søyseth V
Published Date: 6 December 2013
Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD
Bollu V, Ernst FR, Karafilidis J, Rajagopalan K, Robinson SB, Braman SS
Published Date: 6 December 2013
The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data
Kim JH, Rhee CK, Yoo KH, Kim YS, Lee SW, Park YB, Lee JH, Oh YM, Lee SD, Kim Y, Kim KJ, Yoon HK
Published Date: 19 November 2013
Baker CL, Zou KH, Su J
Published Date: 12 November 2013
Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial
Dias FD, Sampaio LMM, da Silva GA, Dantas Gomes ELF, Nascimento ESP, Santos Alves VL, Stirbulov R, Costa D
Published Date: 5 November 2013
P-wave indices in patients with pulmonary emphysema: do P-terminal force and interatrial block have confounding effects?
Chhabra L, Chaubey VK, Kothagundla C, Bajaj R, Kaul S, Spodick DH
Published Date: 14 May 2013