Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Sachin R Pendharkar,Richard Leigh,Michael K Stickland,Danielle A Southern,Christopher H Mody,Maria B Ospina,Mohit Bhutani,Jim Graham,Naushad Hirani,Peter Faris

doi:10.1186/s12890-018-0657-x

Sachin R Pendharkar, Richard Leigh + Show 8 more

Open Access

https://doi.org/10.1186/s12890-018-0657-x

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Abstract

BackgroundVariation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay.MethodsThe order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits.ResultsThere were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions.ConclusionsUse of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care.

Highlights

Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life
Two observational studies have demonstrated that order sets likely improve the quality of hospital care for patients with AECOPD and reduce length of stay (LOS). [13, 16] these studies used pre-post designs that could be influenced by secular trends in AECOPD management, and the studies did not account for the differential effects of the order set among physician groups
Of 1435 AECOPD admissions to one of the three physician groups during the study period, 1413 with a LOS less than 90 days were included in the analysis (Fig. 1)

Summary

Introduction

Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. Evidence-based management guidelines for AECOPD have been developed, [7, 8] and include recommendations regarding pharmacotherapy and post-exacerbation care. Despite these guidelines, hospital care of patients with AECOPD remains highly variable. Two observational studies have demonstrated that order sets likely improve the quality of hospital care for patients with AECOPD and reduce LOS. The objective of this study was to determine whether the implementation of an evidence-based computerized admission order set would improve the quality of inpatient AECOPD care. Preliminary study results have previously been reported in abstract form. [19]

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