Care Bundles after Discharging Patients with Chronic Obstructive Pulmonary Disease Exacerbation from the Emergency Department.

Elisenda Gómez-Angelats,Carolina Sánchez

doi:10.3390/medsci6030063

Abstract

Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs.

Highlights

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for an appreciable number of acute medical admissions, and a significant proportion of these patients are admitted via emergency departments (EDs)
A Chronic obstructive pulmonary disease (COPD) discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from acute exacerbation (AE) COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, there is a lack of consensus of what interventions should be implemented
Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs

Summary

Introduction

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for an appreciable number of acute medical admissions, and a significant proportion of these patients are admitted via emergency departments (EDs). Despite some disparity in the available data, nearly a third of patients are readmitted to hospital within 28 days of discharge [5], and one in five patients requires rehospitalization within 30 days of discharge after and admission for AECOPD [6,7]. Beyond this period of time, there is a considerable variability in outcomes, with 90-day readmission rates ranging between 16% and 48% [8,9]. Despite the existence of clinical practice guidelines for COPD [1,18,19,20,21,22], there is a lack of consensus about discharge bundle interventions that should be implemented in order to reduce the risk of relapses [23]

Care Bundles

Evidence

Could Admission Care Bundles Improve Results and Help Discharge from

Challenges of Implementing Discharge AECOPD Care Bundles

Findings

Conclusions